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NPI Code Detail

MEDICARE: WILLOW PARK CONVALESCENT HOME,INC.

MEDICARE: WILLOW PARK CONVALESCENT HOME,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
1314000000XSkilled Nursing Facility4104OH

Other Identifiers

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

General Provider Information

NPI Number : 1194729038
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILLOW PARK CONVALESCENT HOME,INC.
Provider Business Mailing Address
First Line : 18810 HARVARD AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44122-6848
Country : US
Telephone Number : 216-752-3600
Fax Number : 216-752-5612
Provider Business Practice Location Address
First Line : 18810 HARVARD AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44122-6848
Country : US
Telephone Number : 216-752-3600
Fax Number : 216-752-5612
Authorized Official
Title or Position : AR MANAGER
Name : ADAM J WHITE
Credential : MBA
Telephone Number : 614-416-2638
Provider Enumeration Date : 06/09/2005
Last Update Date : 08/22/2020

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