1649251430 NPI number — WESTLAKE HEALTHCARE CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649251430 NPI number — WESTLAKE HEALTHCARE CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTLAKE HEALTHCARE CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WESTLAKE HEALTHCARE CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649251430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6400 SHAFER CT
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
ROSEMONT
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60018-4914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-720-8722
Provider Business Mailing Address Fax Number:
847-720-8701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 CROCKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTLAKE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44145-6312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-892-2080
Provider Business Practice Location Address Fax Number:
440-892-9299
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STEARNS
Authorized Official First Name:
NEELE
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CHAIRMAN
Authorized Official Telephone Number:
847-720-8720

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2304901 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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