Basic Information
| Provider Information | |||||||||
| NPI: | 1457855983 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AJ CITYVIEW NURSING & REHAB OPCO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 ANTHONY WAYNE TRL | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435661516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307200406 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6606 CARNEGIE AVE | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441034622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163611414 | ||||||||
| FaxNumber: | 2163612822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2018 | ||||||||
| LastUpdateDate: | 04/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | HAYLEY | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | ATTORNEY | ||||||||
| AuthorizedOfficialTelephone: | 2167063936 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1814N | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.