MEDICARE: EMBASSY EUCLID, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1890N	OTHER	OH	LICENSURE

General Provider Information

NPI Number	:	1366119265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBASSY EUCLID, LLC

Provider Business Mailing Address
First Line	:	25201 CHAGRIN BLVD STE 190
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5633
Country	:	US
Telephone Number	:	216-378-2050
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 GATEWAY DRIVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44119-2447
Country	:	US
Telephone Number	:	216-486-4949
Fax Number	:

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	NICHOLAS CICCONE
Credential	:
Telephone Number	:	216-378-2050

Provider Enumeration Date	:	08/27/2021
Last Update Date	:	08/27/2021

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Directions to “EMBASSY EUCLID, LLC ” Practice Location

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