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NPI Code Detail

MEDICARE: SHAKER GARDENS OPCO LLC

MEDICARE: SHAKER GARDENS OPCO 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
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1265028757
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAKER GARDENS OPCO LLC
Provider Business Mailing Address
First Line : 3550 NORTHFIELD RD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-5253
Country : US
Telephone Number : 216-752-5600
Fax Number : 216-491-4262
Provider Business Practice Location Address
First Line : 3550 NORTHFIELD RD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44122-5253
Country : US
Telephone Number : 216-752-5600
Fax Number : 216-491-4262
Authorized Official
Title or Position : CEO
Name : MR. ABBA STEIN
Credential :
Telephone Number : 347-272-4167
Provider Enumeration Date : 12/18/2020
Last Update Date : 12/18/2020

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