Provider Demographics
NPI:1558612721
Name:599 WEST MANOR CORP.
Entity Type:Organization
Organization Name:599 WEST MANOR CORP.
Other - Org Name:RUTH/MATTHEW HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-466-1079
Mailing Address - Street 1:589 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-1361
Mailing Address - Country:US
Mailing Address - Phone:440-466-9521
Mailing Address - Fax:
Practice Address - Street 1:589 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-1361
Practice Address - Country:US
Practice Address - Phone:440-466-9521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities