MEDICARE: MANOR CARE OF MAYFIELD HEIGHTS OH 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	1641N	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	:	1255375580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANOR CARE OF MAYFIELD HEIGHTS OH LLC

Provider Business Mailing Address
First Line	:	333 N SUMMIT ST
Second Line	:	ATTN: BARRY LAZARUS
City	:	TOLEDO
State	:	OH
Zip	:	43604-2615
Country	:	US
Telephone Number	:	419-252-5500
Fax Number	:	877-385-9446

Provider Business Practice Location Address
First Line	:	6757 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-2236
Country	:	US
Telephone Number	:	440-473-0090
Fax Number	:	440-473-4837

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. MARTIN D ALLEN
Credential	:
Telephone Number	:	419-252-5734

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	05/31/2017

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