MEDICARE: BRIAN FAMILY,LTD

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	5539	OH

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	:	1770587768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN FAMILY,LTD

Provider Business Mailing Address
First Line	:	6973 PEARL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-7831
Country	:	US
Telephone Number	:	440-884-9191
Fax Number	:	440-884-5811

Provider Business Practice Location Address
First Line	:	6973 PEARL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-7831
Country	:	US
Telephone Number	:	440-884-9191
Fax Number	:	440-884-5811

Authorized Official
Title or Position	:	AR MANAGER
Name	:	ADAM J WHITE
Credential	:	MBA
Telephone Number	:	614-416-2638

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	08/22/2020

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