Provider Demographics
NPI:1700997855
Name:CLEVELAND HEALTHCARE GROUP, INC.
Entity Type:Organization
Organization Name:CLEVELAND HEALTHCARE GROUP, INC.
Other - Org Name:MIDDLEBURY MANOR NURSING AND REHABILITIATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ITS VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-292-5706
Mailing Address - Street 1:974 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44305-2445
Mailing Address - Country:US
Mailing Address - Phone:330-762-9066
Mailing Address - Fax:330-762-4044
Practice Address - Street 1:974 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-2445
Practice Address - Country:US
Practice Address - Phone:330-762-9066
Practice Address - Fax:330-762-4044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0133314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2513257Medicaid
OH365011Medicare ID - Type Unspecified