Provider Demographics
NPI:1821753724
Name:BUCKEYE FOREST AT CLEVELAND
Entity Type:Organization
Organization Name:BUCKEYE FOREST AT CLEVELAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-327-6982
Mailing Address - Street 1:50 CHESTNUT RIDGE RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-1823
Mailing Address - Country:US
Mailing Address - Phone:908-327-6982
Mailing Address - Fax:
Practice Address - Street 1:16101 EUCLID BEACH BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-1175
Practice Address - Country:US
Practice Address - Phone:216-486-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1589NOtherLICENSURE