Provider Demographics
NPI:1609870138
Name:ELIZA JENNINGS HOME
Entity Type:Organization
Organization Name:ELIZA JENNINGS HOME
Other - Org Name:ELIZA JENNINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BASABI
Authorized Official - Middle Name:
Authorized Official - Last Name:RATNAPARKHI
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:216-226-0282
Mailing Address - Street 1:10603 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1647
Mailing Address - Country:US
Mailing Address - Phone:216-226-0282
Mailing Address - Fax:216-226-8905
Practice Address - Street 1:10603 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1647
Practice Address - Country:US
Practice Address - Phone:216-226-0282
Practice Address - Fax:216-226-8905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIZA JENNINGS SENIOR CARE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-13
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4162314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0278542Medicaid
OH366079Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER