Basic Information
Provider Information
NPI: 1427422088
EntityType: 2
ReplacementNPI:  
OrganizationName: MINERAL RIDGE SKILLED NURSING AND RESIDENTIAL CARE, LLC
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Mailing Information
Address1: 7261 ENGLE RD
Address2: STE 200
City: MIDDLEBURG HEIGHTS
State: OH
PostalCode: 441308467
CountryCode: US
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Practice Location
Address1: 3379 MAIN ST
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City: MINERAL RIDGE
State: OH
PostalCode: 444409735
CountryCode: US
TelephoneNumber: 2167721105
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Other Information
ProviderEnumerationDate: 11/19/2015
LastUpdateDate: 11/19/2015
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AuthorizedOfficialLastName: PARSONS
AuthorizedOfficialFirstName: BENJAMINJ
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AuthorizedOfficialTitleorPosition: GENERAL COUNSEL
AuthorizedOfficialTelephone: 2167723192
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IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X  Y Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

No ID Information.


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