Provider Demographics
NPI:1952879538
Name:PHOENIX MAPLE HEIGHTS OPERATING CO., LLC
Entity Type:Organization
Organization Name:PHOENIX MAPLE HEIGHTS OPERATING CO., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:MOSES
Authorized Official - Last Name:SCHONFELD
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:216-630-1884
Mailing Address - Street 1:23925 GREENLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1434
Mailing Address - Country:US
Mailing Address - Phone:216-630-1884
Mailing Address - Fax:
Practice Address - Street 1:19900 CLARE AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1806
Practice Address - Country:US
Practice Address - Phone:216-662-3343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-13
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility