MEDICARE: MIZPAH HEALTHCARE GROUP 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	NH2632	VA

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	:	1497135727
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIZPAH HEALTHCARE GROUP LLC

Provider Business Mailing Address
First Line	:	23700 COMMERCE PARK
Second Line	:
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5827
Country	:	US
Telephone Number	:	216-292-5706
Fax Number	:

Provider Business Practice Location Address
First Line	:	74 MIZPAH ROAD
Second Line	:
City	:	LOCUST HILL
State	:	VA
Zip	:	23092
Country	:	US
Telephone Number	:	804-758-5260
Fax Number	:	804-758-0953

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM I WEISBERG
Credential	:
Telephone Number	:	216-292-5706

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	01/10/2022

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