Provider Demographics
NPI:1114005659
Name:SPECIALTY HOSPITAL OF CLEVELAND, INC.
Entity Type:Organization
Organization Name:SPECIALTY HOSPITAL OF CLEVELAND, INC.
Other - Org Name:KINDRED HOSPITAL - CLEVELAND - GATEWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-596-7563
Mailing Address - Street 1:680 S 4TH ST
Mailing Address - Street 2:K-LIVE 5 REIMBURSEMENT
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-2407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:502-596-4134
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-592-2830
Practice Address - Fax:216-592-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1434282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000309904OtherBLUE CROSS
OH2420606Medicaid
OH=========OtherAETNA
OH2420606Medicaid
OH000000309904OtherBLUE CROSS
OH=========OtherUNITED HEALTHCARE
OH=========OtherUNITED HEALTHCARE