Provider Demographics
NPI:1558510958
Name:GARDENS OF WESTERN RESERVE ASSISTED LIVING RESIDENCE
Entity Type:Organization
Organization Name:GARDENS OF WESTERN RESERVE ASSISTED LIVING RESIDENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:A
Authorized Official - Last Name:PIEKARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-928-4500
Mailing Address - Street 1:9975 GREENTREE PKWY
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44223
Mailing Address - Country:US
Mailing Address - Phone:330-342-9100
Mailing Address - Fax:330-342-9393
Practice Address - Street 1:9975 GREENTREE PKWY
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-4328
Practice Address - Country:US
Practice Address - Phone:330-342-9100
Practice Address - Fax:330-342-9393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2292R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility