Provider Demographics
NPI:1861727844
Name:BLOOMFIELD SENIOR LIVING OF LAKEWOOD, LLC
Entity type:Organization
Organization Name:BLOOMFIELD SENIOR LIVING OF LAKEWOOD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-854-7104
Mailing Address - Street 1:201 E OHIO ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3629
Mailing Address - Country:US
Mailing Address - Phone:312-854-7104
Mailing Address - Fax:
Practice Address - Street 1:1341 MARLOWE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-2654
Practice Address - Country:US
Practice Address - Phone:216-228-2266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2014R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility