Basic Information
| Provider Information | |||||||||
| NPI: | 1255329041 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LITTLE SISTERS OF THE POOR HOME FOR THE AGED | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4291 RICHMOND RD | ||||||||
| Address2: | |||||||||
| City: | WARRENSVILLE HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441226103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164641222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4291 RICHMOND RD | ||||||||
| Address2: | |||||||||
| City: | WARRENSVILLE HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441226103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2164641222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 01/20/2015 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | KARL | ||||||||
| AuthorizedOfficialFirstName: | SR. MARY | ||||||||
| AuthorizedOfficialMiddleName: | SYLVIA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2164641222 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1303N | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0125966 | 05 | OH | MEDICAID |