Provider Demographics
NPI:1497259923
Name:AJ CANDLEWOOD PARK OPCO LLC
Entity Type:Organization
Organization Name:AJ CANDLEWOOD PARK OPCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-706-3936
Mailing Address - Street 1:555 ANTHONY WAYNE TRL
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43566-1516
Mailing Address - Country:US
Mailing Address - Phone:330-720-0406
Mailing Address - Fax:
Practice Address - Street 1:1835 BELMORE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4301
Practice Address - Country:US
Practice Address - Phone:216-268-3600
Practice Address - Fax:216-761-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1426N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility