MEDICARE: MYOCARE NURSING HOME, 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	314000000X	Skilled Nursing Facility	6181	OH

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	:	1497731541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYOCARE NURSING HOME, INC.

Provider Business Mailing Address
First Line	:	4401 W 150TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1311
Country	:	US
Telephone Number	:	216-252-7555
Fax Number	:	216-251-5886

Provider Business Practice Location Address
First Line	:	4401 W 150TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1311
Country	:	US
Telephone Number	:	216-252-7555
Fax Number	:	216-251-5886

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. NORMAN A FOX
Credential	:
Telephone Number	:	440-617-2113

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	04/09/2010

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