MEDICARE: WARRENSVILLE DEVELOPMENTAL CENTER

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	315P00000X	Intellectual Disabilities Intermediate Care Facility	1812033	OH
2	315P00000X	Intellectual Disabilities Intermediate Care Facility	1812042	OH
3	315P00000X	Intellectual Disabilities Intermediate Care Facility	1812177	OH
4	315P00000X	Intellectual Disabilities Intermediate Care Facility	1812051	OH
5	315P00000X	Intellectual Disabilities Intermediate Care Facility	1812186	OH
6	315P00000X	Intellectual Disabilities Intermediate Care Facility	1812060	OH
7	315P00000X	Intellectual Disabilities Intermediate Care Facility	1812088	OH

General Provider Information

NPI Number	:	1619038239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WARRENSVILLE DEVELOPMENTAL CENTER

Provider Business Mailing Address
First Line	:	4325 GREEN RD
Second Line	:
City	:	HIGHLAND HILLS
State	:	OH
Zip	:	44128-4884
Country	:	US
Telephone Number	:	216-464-7400
Fax Number	:	216-464-4755

Provider Business Practice Location Address
First Line	:	4325 GREEN RD
Second Line	:
City	:	HIGHLAND HILLS
State	:	OH
Zip	:	44128-4884
Country	:	US
Telephone Number	:	216-464-7400
Fax Number	:	216-464-4755

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	WENDY DIGREGORIO
Credential	:
Telephone Number	:	216-464-7400

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	10/31/2008

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Directions to “WARRENSVILLE DEVELOPMENTAL CENTER ” Practice Location

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