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MIDDLEBURG-LEGACY PLACE LLC NPI 1619078938


NPI Information

NPI: 1619078938
Provider Name: MIDDLEBURG-LEGACY PLACE, LLC

Doing Business As: PARKSIDE VILLA

Classification: Skilled Nursing Facility - 314000000X
Entity Type: Organization

CLIA Number: 36D2193753

Address:
7040 HEPBURN RD
CLEVELAND, OH
ZIP 44130
Phone: (216) 898-8399
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MIDDLEBURG-LEGACY PLACE, LLC is a skilled nursing facility in Cleveland, OH. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. MIDDLEBURG-LEGACY PLACE, LLC NPI is 1619078938. The provider is registered as an organization entity type.
The provider Is Doing Business As Parkside Villa.

The provider's business location address is:

7040 HEPBURN RD
CLEVELAND, OH
ZIP 44130-802
Phone: (216) 898-8399
Fax: (216) 898-8455

The provider's authorized official is Bruce Daskal .
The authorized official title is President/ceo and has the following contact phone number (216) 898-8399.

The CLIA number assigned to this NPI record is 36D2193753 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/26/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1314000000XSkilled Nursing Facility6138OHIOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
12288975MEDICAIDOHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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