MEDICARE: LARCHWOOD CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1013482314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARCHWOOD CARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1667
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28603-1667
Country	:	US
Telephone Number	:	828-324-8898
Fax Number	:	828-322-9598

Provider Business Practice Location Address
First Line	:	4110 ROCKY RIVER DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1175
Country	:	US
Telephone Number	:	216-941-6100
Fax Number	:	216-377-7322

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. LOWELL PRENTICE THOMPSON II
Credential	:
Telephone Number	:	216-952-9358

Provider Enumeration Date	:	10/12/2018
Last Update Date	:	10/12/2018

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Directions to “LARCHWOOD CARE LLC ” Practice Location

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