Provider Demographics
NPI:1487866638
Name:599 WEST MAIN CORPORATION
Entity Type:Organization
Organization Name:599 WEST MAIN CORPORATION
Other - Org Name:HOMESTEAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATTORNEY/CHIEF LEGAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-682-2118
Mailing Address - Street 1:599 WEST MAIN ST.
Mailing Address - Street 2:PO BOX 69
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041
Mailing Address - Country:US
Mailing Address - Phone:440-466-1079
Mailing Address - Fax:440-466-2081
Practice Address - Street 1:599 WEST MAIN ST.
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041
Practice Address - Country:US
Practice Address - Phone:440-466-1079
Practice Address - Fax:440-466-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1387315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0378336Medicaid