Provider Demographics
NPI:1336483833
Name:THE INN AT COALRIDGE MANAGEMENT CO. LLC
Entity Type:Organization
Organization Name:THE INN AT COALRIDGE MANAGEMENT CO. LLC
Other - Org Name:THE INN AT COALRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-334-1546
Mailing Address - Street 1:1300 COALRIDGE
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281
Mailing Address - Country:US
Mailing Address - Phone:330-334-1546
Mailing Address - Fax:
Practice Address - Street 1:1300 COALRIDGE
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281
Practice Address - Country:US
Practice Address - Phone:330-334-1546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2609R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility