Basic Information
| Provider Information | |||||||||
| NPI: | 1518562800 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JENNINGS CENTER FOR OLDER ADULTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10204 GRANGER ROAD | ||||||||
| Address2: | |||||||||
| City: | GARFIELD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165812900 | ||||||||
| FaxNumber: | 2165812900 | ||||||||
| Practice Location | |||||||||
| Address1: | 10102 GRANGER ROAD | ||||||||
| Address2: | |||||||||
| City: | GARFIELD HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2165812900 | ||||||||
| FaxNumber: | 2165814505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2020 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOLLIN | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2165812900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JENNINGS CENTER FOR OLDER ADULTS | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.