Provider Demographics
NPI:1700581832
Name:LEGACY NORTH ROYALTON OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:LEGACY NORTH ROYALTON OPERATING COMPANY, LLC
Other - Org Name:LEGACY NORTH ROYALTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-590-0969
Mailing Address - Street 1:12380 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1043
Mailing Address - Country:US
Mailing Address - Phone:216-898-8399
Mailing Address - Fax:440-898-8455
Practice Address - Street 1:9055 W SPRAGUE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44133-1285
Practice Address - Country:US
Practice Address - Phone:440-345-9300
Practice Address - Fax:440-345-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility