Provider Demographics
NPI:1083690135
Name:EAST PARK RETIREMENT COMMUNITY INC
Entity Type:Organization
Organization Name:EAST PARK RETIREMENT COMMUNITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KILBANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-250-4080
Mailing Address - Street 1:8 E PARK CIR
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-3800
Mailing Address - Country:US
Mailing Address - Phone:216-267-7067
Mailing Address - Fax:216-267-5022
Practice Address - Street 1:8 E PARK CIR
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-3800
Practice Address - Country:US
Practice Address - Phone:216-267-7067
Practice Address - Fax:216-267-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH365731314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0760109Medicaid
OH0760109Medicaid