MEDICARE: EUCLID BEACH HEALTHCARE 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	313M00000X	Nursing Facility/Intermediate Care Facility
2	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1427539592
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUCLID BEACH HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	16101 EUCLID BEACH BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-1175
Country	:	US
Telephone Number	:	216-486-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	16101 EUCLID BEACH BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-1175
Country	:	US
Telephone Number	:	937-825-6622
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ARIEL FEIN
Credential	:
Telephone Number	:	516-991-5228

Provider Enumeration Date	:	08/27/2018
Last Update Date	:	12/15/2020

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