Provider Demographics
NPI:1033250451
Name:SHAKER HEIGHTS, LTC, LLC
Entity Type:Organization
Organization Name:SHAKER HEIGHTS, LTC, LLC
Other - Org Name:SHAKER GARDENS NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-752-5600
Mailing Address - Street 1:3550 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5253
Mailing Address - Country:US
Mailing Address - Phone:216-752-5600
Mailing Address - Fax:216-752-8133
Practice Address - Street 1:3550 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5253
Practice Address - Country:US
Practice Address - Phone:216-752-5600
Practice Address - Fax:216-752-8133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2047N313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2625976Medicaid
OH366021Medicare ID - Type Unspecified