MEDICARE: NORTH OLMSTED HEALTHCARE 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	:	1023591161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH OLMSTED HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	544 ENTERPRISE DR
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-9704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23225 LORAIN RD
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-1624
Country	:	US
Telephone Number	:	440-779-6900
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	PAUL BERGSTEN
Credential	:
Telephone Number	:	937-825-6622

Provider Enumeration Date	:	09/14/2018
Last Update Date	:	09/14/2018

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