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General NPI Number Information
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NPI Number | 1982020335
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Entity Type | Organization
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Legal Business Name | MENORAH PARK AMBULANCE AND MEDICAL TRANSPORTATION, LLC
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 27100 CEDAR RD
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City | BEACHWOOD
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State | OH
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Zip | 44122-1109
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Country | US
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Telephone | 216-831-6500
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Fax | 216-831-5492
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Provider Business Mailing Address
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Address Line | 27100 CEDAR RD
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City | BEACHWOOD
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State | OH
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Zip | 44122-1109
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Country | US
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Telephone | 216-831-6500
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Fax | 216-831-5492
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Authorized Official
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Title or Position | CEO
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Name | STEVEN RAICHILSON
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Credential |
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Telephone | 216-831-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 04167
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 188815
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License Number State | OH
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