Basic Information
| Provider Information | |||||||||
| NPI: | 1700189784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEDARVIEW NURSING & REHABILITATION CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 S GREEN RD | ||||||||
| Address2: | SUITE 02 | ||||||||
| City: | SOUTH EUCLID | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441213349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2163815794 | ||||||||
| FaxNumber: | 2163815797 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 OREGONIA RD | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450361983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139321121 | ||||||||
| FaxNumber: | 5139340899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2010 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | HERTANU | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2163815794 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.