Provider Demographics
NPI:1497731541
Name:MYOCARE NURSING HOME, INC.
Entity Type:Organization
Organization Name:MYOCARE NURSING HOME, INC.
Other - Org Name:WESTPARK NEUROLOGY & REHABILITATION CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-617-2113
Mailing Address - Street 1:4401 W 150TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1311
Mailing Address - Country:US
Mailing Address - Phone:216-252-7555
Mailing Address - Fax:216-251-5886
Practice Address - Street 1:4401 W 150TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1311
Practice Address - Country:US
Practice Address - Phone:216-252-7555
Practice Address - Fax:216-251-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-21
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6181314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2784705Medicaid
OH365796Medicare Oscar/Certification