Provider Demographics
NPI:1629531058
Name:LARCHWOOD CARE LLC
Entity Type:Organization
Organization Name:LARCHWOOD CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:PRENTICE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:216-952-9358
Mailing Address - Street 1:4106 ROCKY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-1174
Mailing Address - Country:US
Mailing Address - Phone:216-941-6100
Mailing Address - Fax:216-377-7322
Practice Address - Street 1:4106 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1174
Practice Address - Country:US
Practice Address - Phone:216-941-6100
Practice Address - Fax:216-377-7322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LARCHWOOD CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-11
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2493ROtherLICENSE NUMBER