MEDICARE: SPECIALTY HOSPITAL OF CLEVELAND, 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	282E00000X	Long Term Care Hospital

General Provider Information

NPI Number	:	1447321906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIALTY HOSPITAL OF CLEVELAND, INC.

Provider Business Mailing Address
First Line	:	680 S 4TH ST
Second Line	:	K-LIVE 5 REIMBURSEMENT
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-2407
Country	:	US
Telephone Number	:
Fax Number	:	502-596-4134

Provider Business Practice Location Address
First Line	:	11900 FAIRHILL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1053
Country	:	US
Telephone Number	:	216-983-8030
Fax Number	:

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	MARILYN A. WEAVER
Credential	:
Telephone Number	:	502-596-7563

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	11/10/2016

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