Basic Information
| Provider Information | |||||||||
| NPI: | 1629233929 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FALLING WATER RETIREMENT COMMUNITY INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | CYRSTAL WATERS RETIREMENT COMMUNITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 BEREA COMMONS | ||||||||
| Address2: | SUITE ONE | ||||||||
| City: | BEREA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440172500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402435668 | ||||||||
| FaxNumber: | 4402433049 | ||||||||
| Practice Location | |||||||||
| Address1: | 18960 FALLING WATER RD | ||||||||
| Address2: | |||||||||
| City: | STRONGSVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441364233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402383600 | ||||||||
| FaxNumber: | 4402384920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2008 | ||||||||
| LastUpdateDate: | 07/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | COURY | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SECRETARY/TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 4402435668 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 2334R | OH | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.