Provider Demographics
NPI:1164836441
Name:WESTERN RESERVE HEALTHCARE CO., LLC
Entity type:Organization
Organization Name:WESTERN RESERVE HEALTHCARE CO., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-474-3027
Mailing Address - Street 1:8881 SCHAEFFER ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5035
Mailing Address - Country:US
Mailing Address - Phone:440-255-9309
Mailing Address - Fax:
Practice Address - Street 1:8881 SCHAEFFER ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5035
Practice Address - Country:US
Practice Address - Phone:440-266-3909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility