Provider Demographics
NPI:1144747320
Name:LANTERN OF CHAGRIN VALLEY
Entity Type:Organization
Organization Name:LANTERN OF CHAGRIN VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NESIAN
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MAKESH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, MBA
Authorized Official - Phone:440-796-1157
Mailing Address - Street 1:5277 CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-4334
Mailing Address - Country:US
Mailing Address - Phone:440-557-1186
Mailing Address - Fax:440-338-1435
Practice Address - Street 1:5277 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-4334
Practice Address - Country:US
Practice Address - Phone:440-557-1186
Practice Address - Fax:440-338-1435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2744R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility