Provider Demographics
NPI:1376133678
Name:MIDDLEBURG HEIGHTS NURSING HOME LLC
Entity Type:Organization
Organization Name:MIDDLEBURG HEIGHTS NURSING HOME LLC
Other - Org Name:O'NEILL HEALTHCARE MIDDLEBURG HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:440-387-5555
Mailing Address - Street 1:38642 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-5812
Mailing Address - Country:US
Mailing Address - Phone:440-387-5551
Mailing Address - Fax:440-327-6172
Practice Address - Street 1:7250 OLD OAK BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-387-5555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility