Provider Demographics
NPI:1225299019
Name:MYOCARE NURSING HOME INC
Entity Type:Organization
Organization Name:MYOCARE NURSING HOME INC
Other - Org Name:COVENANT - LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:440-617-2103
Mailing Address - Street 1:24340 SPERRY DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1565
Mailing Address - Country:US
Mailing Address - Phone:440-617-2103
Mailing Address - Fax:
Practice Address - Street 1:4401 W 150TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1311
Practice Address - Country:US
Practice Address - Phone:216-252-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0912921291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory