Provider Demographics
NPI:1740397835
Name:HARBORSIDE OF CLEVELAND LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:HARBORSIDE OF CLEVELAND LIMITED PARTNERSHIP
Other - Org Name:WEST BAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4742
Mailing Address - Street 1:27601 WESTCHESTER PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1251
Mailing Address - Country:US
Mailing Address - Phone:440-871-5900
Mailing Address - Fax:440-871-5901
Practice Address - Street 1:27601 WESTCHESTER PKWY
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1251
Practice Address - Country:US
Practice Address - Phone:440-871-5900
Practice Address - Fax:440-871-5901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNBRIDGE HEALTHCARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-24
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5159314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2281374Medicaid
OH2281374Medicaid