Provider Demographics
NPI:1982002796
Name:ROSE CENTERS FOR AGING WELL LLC
Entity Type:Organization
Organization Name:ROSE CENTERS FOR AGING WELL LLC
Other - Org Name:GOLDEN AGE CENTERS OF GREATER CLEVELAND
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DABNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-373-1954
Mailing Address - Street 1:11890 FAIRHILL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1053
Mailing Address - Country:US
Mailing Address - Phone:216-791-8000
Mailing Address - Fax:216-373-1816
Practice Address - Street 1:11890 FAIRHILL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1053
Practice Address - Country:US
Practice Address - Phone:216-791-8000
Practice Address - Fax:216-373-1816
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENJAMIN ROSE INSTITUTE ON AGING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-10
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0112031Medicaid