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NPI Code Detail

MEDICARE: CRESTMONT NURSING HOME NORTH CORP.

MEDICARE: CRESTMONT NURSING HOME NORTH CORP.
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
1313M00000XNursing Facility/Intermediate Care Facility4284OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487656773
Entity Type Code : Organization
Provider Name (Legal Business Name) : CRESTMONT NURSING HOME NORTH CORP.
Provider Business Mailing Address
First Line : 13330 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-2850
Country : US
Telephone Number : 216-539-7846
Fax Number : 216-521-1212
Provider Business Practice Location Address
First Line : 13330 DETROIT AVE
Second Line :
City : LAKEWOOD
State : OH
Zip : 44107-2850
Country : US
Telephone Number : 216-228-9550
Fax Number : 216-521-2193
Authorized Official
Title or Position : OWNER
Name : MR. ELIAS J COURY
Credential :
Telephone Number : 216-539-7846
Provider Enumeration Date : 06/01/2005
Last Update Date : 10/03/2022

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