Provider Demographics
NPI:1568139467
Name:EMBASSY LYNDHURST, LLC
Entity Type:Organization
Organization Name:EMBASSY LYNDHURST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CICCONE
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:216-378-2050
Mailing Address - Street 1:25201 CHAGRIN BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5633
Mailing Address - Country:US
Mailing Address - Phone:216-378-2050
Mailing Address - Fax:
Practice Address - Street 1:1575 BRAINARD RD
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-3096
Practice Address - Country:US
Practice Address - Phone:440-460-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-27
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2089NOtherLICENSURE