Provider Demographics
NPI:1700370640
Name:3660 GREENTREE LEASING, LLC
Entity Type:Organization
Organization Name:3660 GREENTREE LEASING, LLC
Other - Org Name:THE LODGE AT NEW DAWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUNZBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-367-1214
Mailing Address - Street 1:29225 CHAGRIN BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4632
Mailing Address - Country:US
Mailing Address - Phone:216-367-1214
Mailing Address - Fax:866-629-9730
Practice Address - Street 1:3660 GREENTREE AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-4024
Practice Address - Country:US
Practice Address - Phone:330-484-5888
Practice Address - Fax:330-484-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2758N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility