MEDICARE: ARISTOCRAT WEST NURSING HOME 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
1	314000000X	Skilled Nursing Facility	PENDING	OH

General Provider Information

NPI Number	:	1700068814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARISTOCRAT WEST NURSING HOME CORP

Provider Business Mailing Address
First Line	:	4387 W 150TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1355
Country	:	US
Telephone Number	:	216-252-7730
Fax Number	:	216-688-3056

Provider Business Practice Location Address
First Line	:	4387 W 150TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1355
Country	:	US
Telephone Number	:	216-252-7730
Fax Number	:	216-688-3056

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

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	11/30/2007

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