Provider Demographics
NPI:1760486153
Name:JENNINGS CENTER FOR OLDER ADULTS
Entity Type:Organization
Organization Name:JENNINGS CENTER FOR OLDER ADULTS
Other - Org Name:JENNINGS HALL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:Q
Authorized Official - Last Name:SALOPECK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LNHA
Authorized Official - Phone:216-581-2900
Mailing Address - Street 1:10204 GRANGER RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-3106
Mailing Address - Country:US
Mailing Address - Phone:216-581-2900
Mailing Address - Fax:216-581-4505
Practice Address - Street 1:10204 GRANGER RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-3106
Practice Address - Country:US
Practice Address - Phone:216-581-2900
Practice Address - Fax:216-581-4505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 261QA0600X
OH000512N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251E00000XAgenciesHome Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0169286Medicaid
OH366045Medicare ID - Type UnspecifiedPROVIDER LEGACY NUMBER