Provider Demographics
NPI:1225160096
Name:BEREA LAKE TOWERS, INC.
Entity Type:Organization
Organization Name:BEREA LAKE TOWERS, INC.
Other - Org Name:BEREA LAKE TOWERS RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:COURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-243-5668
Mailing Address - Street 1:4 BEREA COMMONS
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2524
Mailing Address - Country:US
Mailing Address - Phone:440-243-9050
Mailing Address - Fax:440-891-0196
Practice Address - Street 1:4 BEREA COMMONS
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-2524
Practice Address - Country:US
Practice Address - Phone:440-243-9050
Practice Address - Fax:440-891-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6206310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2707913Medicaid