MEDICARE: KEMPER HOUSE OLMSTED FALLS

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	311500000X	Alzheimer Center (Dementia Center)	5957	OH

General Provider Information

NPI Number	:	1740414960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEMPER HOUSE OLMSTED FALLS

Provider Business Mailing Address
First Line	:	25880 ELM ST
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-1614
Country	:	US
Telephone Number	:	440-235-5500
Fax Number	:	440-235-5850

Provider Business Practice Location Address
First Line	:	25880 ELM ST
Second Line	:
City	:	OLMSTED FALLS
State	:	OH
Zip	:	44138-1614
Country	:	US
Telephone Number	:	440-235-5500
Fax Number	:	440-235-5850

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RITA HABORAK
Credential	:
Telephone Number	:	440-235-5500

Provider Enumeration Date	:	05/04/2009
Last Update Date	:	05/04/2009

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