Provider Demographics
NPI:1073624128
Name:CLEVELAND HEALTHCARE GROUP, INC
Entity Type:Organization
Organization Name:CLEVELAND HEALTHCARE GROUP, INC
Other - Org Name:WALTON MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ITS VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-292-5706
Mailing Address - Street 1:19859 ALEXANDER RD
Mailing Address - Street 2:
Mailing Address - City:WALTON HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-5345
Mailing Address - Country:US
Mailing Address - Phone:440-439-4433
Mailing Address - Fax:440-439-0691
Practice Address - Street 1:19859 ALEXANDER RD
Practice Address - Street 2:
Practice Address - City:WALTON HILLS
Practice Address - State:OH
Practice Address - Zip Code:44146-5345
Practice Address - Country:US
Practice Address - Phone:440-439-4433
Practice Address - Fax:440-439-0691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1873314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2513266Medicaid
OH2513266Medicaid