MEDICARE: WELLINGTON PLACE, 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	2329R	OH
2	314000000X	Skilled Nursing Facility	2329-N	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2329-R	OTHER	OH	RESIDENTIAL CARE LICENSE
2	2329-N	OTHER	OH	NURSING HOME LICENSE

General Provider Information

NPI Number	:	1841347200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLINGTON PLACE, LLC

Provider Business Mailing Address
First Line	:	34100 CENTER RIDGE RD
Second Line	:	SUITE 10
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-5311
Country	:	US
Telephone Number	:	440-327-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 CLAGUE RD
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-6207
Country	:	US
Telephone Number	:	440-734-9933
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN T. O'NEILL
Credential	:
Telephone Number	:	440-387-5500

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	09/16/2024

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Directions to “WELLINGTON PLACE, LLC ” Practice Location

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