Provider Demographics
NPI:1912374083
Name:EMBASSY LONGMEADOW LLC
Entity Type:Organization
Organization Name:EMBASSY LONGMEADOW LLC
Other - Org Name:LONGMEADOW CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-706-3936
Mailing Address - Street 1:24579 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44146-6338
Mailing Address - Country:US
Mailing Address - Phone:330-297-5781
Mailing Address - Fax:330-297-6921
Practice Address - Street 1:565 BRYN MAWR ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9696
Practice Address - Country:US
Practice Address - Phone:330-297-5781
Practice Address - Fax:330-297-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-25
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1628N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH365354Medicare Oscar/Certification