Provider Demographics
NPI:1720410178
Name:LARCHWOOD HEALTH GROUP LLC
Entity Type:Organization
Organization Name:LARCHWOOD HEALTH GROUP LLC
Other - Org Name:LARCHWOOD VILLAGE RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VERZI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-937-0425
Mailing Address - Street 1:14518 DETROIT AVE REAR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4368
Mailing Address - Country:US
Mailing Address - Phone:216-273-7532
Mailing Address - Fax:
Practice Address - Street 1:4110 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-1175
Practice Address - Country:US
Practice Address - Phone:440-937-0425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092162Medicaid
OH366359Medicare PIN