MEDICARE: TWINSBURG-LEGACY ASSISTED LIVING, L.L.C.

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	310400000X	Assisted Living Facility	5648	OH

General Provider Information

NPI Number	:	1710123203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWINSBURG-LEGACY ASSISTED LIVING, L.L.C.

Provider Business Mailing Address
First Line	:	9928 VAIL DR
Second Line	:
City	:	TWINSBURG
State	:	OH
Zip	:	44087-2972
Country	:	US
Telephone Number	:	330-405-6040
Fax Number	:	330-405-6041

Provider Business Practice Location Address
First Line	:	9928 VAIL DR
Second Line	:
City	:	TWINSBURG
State	:	OH
Zip	:	44087-2972
Country	:	US
Telephone Number	:	330-405-6040
Fax Number	:	330-405-6041

Authorized Official
Title or Position	:	VP, BUS. DEVEL.
Name	:	MR. STEVEN DORON DASKAL
Credential	:	LNHA
Telephone Number	:	216-898-8399

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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