1629015433 NPI number — ALLIANCE HEALTHCARE BRAEVIEW, INC.

Table of content: (NPI 1629015433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629015433 NPI number — ALLIANCE HEALTHCARE BRAEVIEW, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE HEALTHCARE BRAEVIEW, INC.
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:
BRAEVIEW CARE AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
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:
1629015433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29225 CHAGRIN BLVD.
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-658-1040
Provider Business Mailing Address Fax Number:
866-629-9730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20611 EUCLID AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUCLID
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-486-9300
Provider Business Practice Location Address Fax Number:
216-486-2603
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUNZBURG
Authorized Official First Name:
ELI
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
440-658-1040

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  6127 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 6127 , 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)

  • Identifier: 2170709 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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