Provider Demographics
NPI:1336454800
Name:EMBASSY BROADWAY MANAGEMENT, LLC
Entity Type:Organization
Organization Name:EMBASSY BROADWAY MANAGEMENT, LLC
Other - Org Name:BROADWAY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-662-0551
Mailing Address - Street 1:16231 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2526
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16231 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2526
Practice Address - Country:US
Practice Address - Phone:216-662-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMBASSY BROADWAY MANAGEMENT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory