Provider Demographics
NPI:1104032705
Name:MENORAH PARK CENTER FOR SENIOR LIVING
Entity Type:Organization
Organization Name:MENORAH PARK CENTER FOR SENIOR LIVING
Other - Org Name:MENORAH PARK HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JULIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-831-6500
Mailing Address - Street 1:27100 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1109
Mailing Address - Country:US
Mailing Address - Phone:216-831-6500
Mailing Address - Fax:216-831-5492
Practice Address - Street 1:27100 CEDAR RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1109
Practice Address - Country:US
Practice Address - Phone:216-831-6500
Practice Address - Fax:216-831-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251C00000X, 261QA0600X
OH5870251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2023303Medicaid
OH367617Medicare ID - Type UnspecifiedHOME HEALTH