Provider Demographics
NPI:1750340428
Name:SOLAMOR HOSPICE CORPORATION
Entity type:Organization
Organization Name:SOLAMOR HOSPICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-899-7659
Mailing Address - Street 1:837 CROCKER RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1028
Mailing Address - Country:US
Mailing Address - Phone:440-899-7659
Mailing Address - Fax:440-899-9029
Practice Address - Street 1:837 CROCKER RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-1028
Practice Address - Country:US
Practice Address - Phone:440-899-7659
Practice Address - Fax:440-899-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0107HSP315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0055747Medicaid
OH361598Medicare Oscar/Certification