Provider Demographics
NPI:1265028757
Name:SHAKER GARDENS OPCO LLC
Entity Type:Organization
Organization Name:SHAKER GARDENS OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ABBA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-272-4167
Mailing Address - Street 1:3550 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5253
Mailing Address - Country:US
Mailing Address - Phone:216-752-5600
Mailing Address - Fax:216-491-4262
Practice Address - Street 1:3550 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5253
Practice Address - Country:US
Practice Address - Phone:216-752-5600
Practice Address - Fax:216-491-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility