Provider Demographics
NPI:1043513625
Name:EMBASSY HOMECARE, LLC
Entity Type:Organization
Organization Name:EMBASSY HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:BUTERA
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:216-706-3864
Mailing Address - Street 1:24579 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-6338
Mailing Address - Country:US
Mailing Address - Phone:440-439-7976
Mailing Address - Fax:
Practice Address - Street 1:24579 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:OAKWOOD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44146-6338
Practice Address - Country:US
Practice Address - Phone:440-439-7976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home