MEDICARE: LARCHWOOD HEALTH GROUP 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	310400000X	Assisted Living Facility
2	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

General Provider Information

NPI Number	:	1720410178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARCHWOOD HEALTH GROUP LLC

Provider Business Mailing Address
First Line	:	14518 DETROIT AVE REAR
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4368
Country	:	US
Telephone Number	:	216-273-7532
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 ROCKY RIVER DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-1175
Country	:	US
Telephone Number	:	440-937-0425
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MS. MELISSA VERZI
Credential	:
Telephone Number	:	440-937-0425

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	04/10/2014

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Directions to “LARCHWOOD HEALTH GROUP LLC ” Practice Location

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