Provider Demographics
NPI:1083777577
Name:SHCP MEDINA INC.
Entity Type:Organization
Organization Name:SHCP MEDINA INC.
Other - Org Name:MEDINA MEADOWS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-706-3936
Mailing Address - Street 1:5625 EMERALD RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1860
Mailing Address - Country:US
Mailing Address - Phone:440-498-3000
Mailing Address - Fax:440-498-8257
Practice Address - Street 1:550 MINER DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1472
Practice Address - Country:US
Practice Address - Phone:330-725-1550
Practice Address - Fax:330-725-8322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1740N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2184818Medicaid
OH2184818Medicaid