MEDICARE: INNER CITY NURSING 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
1	314000000X	Skilled Nursing Facility	0713	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	:	1306835905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER CITY NURSING HOME INC

Provider Business Mailing Address
First Line	:	9014 CEDAR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2932
Country	:	US
Telephone Number	:	216-795-1363
Fax Number	:	216-795-1573

Provider Business Practice Location Address
First Line	:	9014 CEDAR AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2932
Country	:	US
Telephone Number	:	216-795-1363
Fax Number	:	216-795-1573

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MR. MELVIN GEORGE PYE
Credential	:
Telephone Number	:	216-795-1363

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	03/09/2012

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Directions to “INNER CITY NURSING HOME INC ” Practice Location

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