Provider Demographics
NPI:1982020335
Name:MENORAH PARK AMBULANCE AND MEDICAL TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:MENORAH PARK AMBULANCE AND MEDICAL TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAICHILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-831-6500
Mailing Address - Street 1:27100 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1109
Mailing Address - Country:US
Mailing Address - Phone:216-831-6500
Mailing Address - Fax:216-831-5492
Practice Address - Street 1:27100 CEDAR RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1109
Practice Address - Country:US
Practice Address - Phone:216-831-6500
Practice Address - Fax:216-831-5492
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENORAH PARK CENTER FOR SENIOR LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH041673416L0300X
OH188815343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH011510Medicare Oscar/Certification