Provider Demographics
NPI:1093705717
Name:RAE-ANN WESTLAKE, INC.
Entity Type:Organization
Organization Name:RAE-ANN WESTLAKE, INC.
Other - Org Name:M.A.G., INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRIFFITHS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:440-835-3005
Mailing Address - Street 1:PO BOX 40175
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-0175
Mailing Address - Country:US
Mailing Address - Phone:440-835-3005
Mailing Address - Fax:440-871-3776
Practice Address - Street 1:28303 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2157
Practice Address - Country:US
Practice Address - Phone:440-871-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-25
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5390314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050215Medicaid
OH0050215Medicaid