Basic Information
| Provider Information | |||||||||
| NPI: | 1780847723 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CLASSIC HEALTHCARE SYSTEMS, LLC | ||||||||
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| OtherOrganizationName: | FRANKLIN RIDGE HEALTH CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 BEREA COMMONS | ||||||||
| Address2: | SUITE ONE | ||||||||
| City: | BEREA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440172535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402435668 | ||||||||
| FaxNumber: | 4402433049 | ||||||||
| Practice Location | |||||||||
| Address1: | 421 MISSION LN | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450052327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377463943 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2008 | ||||||||
| LastUpdateDate: | 10/10/2008 | ||||||||
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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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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
ID Information
| ID | Type | State | Issuer | Description | 2900883 | 05 | OH | MEDICAID |