Basic Information
| Provider Information | |||||||||
| NPI: | 1992050322 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMBASSY ROYAL OAK, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24579 BROADWAY AVE | ||||||||
| Address2: | |||||||||
| City: | OAKWOOD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441466338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4404397976 | ||||||||
| FaxNumber: | 4402327113 | ||||||||
| Practice Location | |||||||||
| Address1: | 6973 PEARL RD | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441307831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408849191 | ||||||||
| FaxNumber: | 4408845811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2012 | ||||||||
| LastUpdateDate: | 07/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | HANDLER | ||||||||
| AuthorizedOfficialFirstName: | AARON | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4404397976 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 1913N | OH | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.