Provider Demographics
NPI:1376516328
Name:HAMLET HEALTH CARE OPERATOR LLC
Entity Type:Organization
Organization Name:HAMLET HEALTH CARE OPERATOR LLC
Other - Org Name:THE MANOR AT HAMLET VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUGGILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-222-5275
Mailing Address - Street 1:200 HAMLET HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-2985
Mailing Address - Country:US
Mailing Address - Phone:440-247-4201
Mailing Address - Fax:440-247-1291
Practice Address - Street 1:150 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-2985
Practice Address - Country:US
Practice Address - Phone:440-247-4200
Practice Address - Fax:440-247-7597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAMLET OPERATOR HOLDING LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-09
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0510N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0117034Medicaid
OH366274Medicare Oscar/Certification