Provider Demographics
NPI:1598828907
Name:SNF WADSWORTH LLC
Entity Type:Organization
Organization Name:SNF WADSWORTH LLC
Other - Org Name:GOLDEN LEAF REHAB & NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-498-3000
Mailing Address - Street 1:5625 EMERALD RIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-1860
Mailing Address - Country:US
Mailing Address - Phone:440-498-3000
Mailing Address - Fax:440-498-8257
Practice Address - Street 1:540 GREAT OAKS TRL
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8799
Practice Address - Country:US
Practice Address - Phone:330-336-3472
Practice Address - Fax:330-334-2026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2350N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2319717Medicaid
OH2319717Medicaid