MEDICARE: EMBASSY ROYAL OAK, 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	314000000X	Skilled Nursing Facility	1913N	OH

General Provider Information

NPI Number	:	1992050322
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBASSY ROYAL OAK, LLC

Provider Business Mailing Address
First Line	:	24579 BROADWAY AVE
Second Line	:
City	:	OAKWOOD VILLAGE
State	:	OH
Zip	:	44146-6338
Country	:	US
Telephone Number	:	440-439-7976
Fax Number	:	440-232-7113

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	:	MANAGING MEMBER
Name	:	AARON B HANDLER
Credential	:
Telephone Number	:	440-439-7976

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	07/23/2012

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