1992050322 NPI number — EMBASSY ROYAL OAK, LLC

Table of content: (NPI 1992050322)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992050322 NPI number — EMBASSY ROYAL OAK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBASSY ROYAL OAK, 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:
Provider Other Organization Name Type Code:
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:
1992050322
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24579 BROADWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKWOOD VILLAGE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44146-6338
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-439-7976
Provider Business Mailing Address Fax Number:
440-232-7113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6973 PEARL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-7831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-884-9191
Provider Business Practice Location Address Fax Number:
440-884-5811
Provider Enumeration Date:
07/23/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HANDLER
Authorized Official First Name:
AARON
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
440-439-7976

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1913N , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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