MEDICARE: EAST PARK RETIREMENT COMMUNITY INC

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	365731	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083690135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST PARK RETIREMENT COMMUNITY INC

Provider Business Mailing Address
First Line	:	8 E PARK CIR
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-3800
Country	:	US
Telephone Number	:	216-267-7067
Fax Number	:	216-267-5022

Provider Business Practice Location Address
First Line	:	8 E PARK CIR
Second Line	:
City	:	BROOKPARK
State	:	OH
Zip	:	44142-3800
Country	:	US
Telephone Number	:	216-267-7067
Fax Number	:	216-267-5022

Authorized Official
Title or Position	:	ASSISTANT DIRECTOR OF OPERATIONS
Name	:	MRS. EILEEN KILBANE
Credential	:
Telephone Number	:	440-250-4080

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/29/2013

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Directions to “EAST PARK RETIREMENT COMMUNITY INC ” Practice Location

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