Provider Demographics
NPI:1801570221
Name:EMBASSY FOREST HILLS
Entity type:Organization
Organization Name:EMBASSY FOREST HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CICCONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-468-6322
Mailing Address - Street 1:2841 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4037
Mailing Address - Country:US
Mailing Address - Phone:614-891-1111
Mailing Address - Fax:614-794-6281
Practice Address - Street 1:2841 E DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4037
Practice Address - Country:US
Practice Address - Phone:614-891-1111
Practice Address - Fax:614-794-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care