Provider Demographics
NPI:1235317694
Name:ROCKY RIVER LEASING CO., LLC
Entity Type:Organization
Organization Name:ROCKY RIVER LEASING CO., LLC
Other - Org Name:NORTHWESTERN HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF A/R
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-489-7100
Mailing Address - Street 1:4700 ASHWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2465
Mailing Address - Country:US
Mailing Address - Phone:513-489-7100
Mailing Address - Fax:
Practice Address - Street 1:570 N ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017-1613
Practice Address - Country:US
Practice Address - Phone:440-243-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2815538Medicaid
OH2815538Medicaid
OH6091670001Medicare NSC