Provider Demographics
NPI:1497999106
Name:ELIZA JENNINGS INC
Entity type:Organization
Organization Name:ELIZA JENNINGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:FANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-288-5886
Mailing Address - Street 1:16695 CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023
Mailing Address - Country:US
Mailing Address - Phone:440-543-4221
Mailing Address - Fax:440-543-1232
Practice Address - Street 1:16695 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4578
Practice Address - Country:US
Practice Address - Phone:440-543-4221
Practice Address - Fax:440-543-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6210310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility