Basic Information
| Provider Information | |||||||||
| NPI: | 1568139467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMBASSY LYNDHURST, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25201 CHAGRIN BLVD STE 190 | ||||||||
| Address2: | |||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163782050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1575 BRAINARD RD | ||||||||
| Address2: | |||||||||
| City: | LYNDHURST | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441243096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404601000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2021 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | CICCONE | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF COMPLIANCE OFFICE | ||||||||
| AuthorizedOfficialTelephone: | 2163782050 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ESQ | ||||||||
| NPICertificationDate: | 09/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 2089N | 01 | OH | LICENSURE | OTHER |