Provider Demographics
NPI:1538239314
Name:MONTEFIORE HOME
Entity type:Organization
Organization Name:MONTEFIORE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-360-9080
Mailing Address - Street 1:ONE DAVID N MYERS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1162
Mailing Address - Country:US
Mailing Address - Phone:216-910-2641
Mailing Address - Fax:216-910-2299
Practice Address - Street 1:ONE DAVID N MYERS PARKWAY
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-910-2641
Practice Address - Fax:216-910-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332BN1400X332BN1400X
OH332BP3500X332BP3500X
OH1956N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0346700001OtherMEDICARE NSC
OH0025690Medicaid
OH365046Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER