Provider Demographics
NPI:1861490245
Name:ATHENIAN ASSISTED LIVING CENTER
Entity Type:Organization
Organization Name:ATHENIAN ASSISTED LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOULA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAITANAROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-225-8054
Mailing Address - Street 1:1026 PEARL RD
Mailing Address - Street 2:SUITE #5
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-2516
Mailing Address - Country:US
Mailing Address - Phone:330-225-8054
Mailing Address - Fax:330-225-9094
Practice Address - Street 1:12799 DOULA LN
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-1020
Practice Address - Country:US
Practice Address - Phone:440-877-1900
Practice Address - Fax:440-877-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3060310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility