36D0929858 CLIA NUMBER - CRESTMONT NURSING HOME NORTH CORP DBA CRESTMONT NORTH NURSING HOME

Laboratory Demographics

CLIA Number: 36D0929858

Facility Name: CRESTMONT NURSING HOME NORTH CORP DBA CRESTMONT NORTH NURSING HOME

Facility Address:
13330 DETROIT AVENUE
LAKEWOOD, OH
ZIP 44107
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Facility Phone Number: 216 228-9550

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1487656773

Taxonomy: 313M00000X - Nursing Facility/Intermediate Care Facility
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.

CLIA Record

Field Name	Field Value
CLIA Number	36D0929858
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	CRESTMONT NURSING HOME NORTH CORP DBA CRESTMONT NORTH NURSING HOME
Street	13330 DETROIT AVENUE
City	LAKEWOOD
State	OH
ZIP	44107
Phone	216 228-9550
CertificateType	4
CertificateEffectiveDate	6/25/2023
CertificateExpirationDate	6/24/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024