Provider Demographics
NPI:1235115387
Name:OLMSTED MANOR, LTD
Entity Type:Organization
Organization Name:OLMSTED MANOR, LTD
Other - Org Name:JOSHUA TREE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MROCZKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-835-1181
Mailing Address - Street 1:27500 MILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-3115
Mailing Address - Country:US
Mailing Address - Phone:440-777-8444
Mailing Address - Fax:440-777-5796
Practice Address - Street 1:27500 MILL RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070
Practice Address - Country:US
Practice Address - Phone:440-777-8444
Practice Address - Fax:440-777-5796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH365533314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2019612Medicaid
OH365533Medicare ID - Type Unspecified