MEDICARE: MOUNT ROYAL VILLA 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

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
2	1138N	OTHER	OH	OHIO DEPARTMENT OF HEALTH HOME NUMBER

General Provider Information

NPI Number	:	1619495918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT ROYAL VILLA LLC

Provider Business Mailing Address
First Line	:	270 MADISON AVE FL 17
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-0601
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13900 BENNETT RD
Second Line	:
City	:	NORTH ROYALTON
State	:	OH
Zip	:	44133
Country	:	US
Telephone Number	:	440-237-7966
Fax Number	:

Authorized Official
Title or Position	:	SENIOR VICE PRESIDENT
Name	:	EPHRAM LAHASKY
Credential	:
Telephone Number	:	646-772-3668

Provider Enumeration Date	:	09/07/2017
Last Update Date	:	12/11/2025

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