Eliza Bryant Village

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3660 Issued in OH

Legal business name

ELIZA BRYANT VILLAGE

Practice address

7201 Wade Park Ave
Cleveland, OH 44103

Phone

(216) 361-6141

Fax

(216) 588-1982

NPI assigned

Sep 27, 2005

Organization subpart

Yes

Parent organization

ELIZA BRYANT VILLAGEAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Danny Williams, JD, LNHA

Title

President/Ceo

Phone

(216) 361-6141

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Eliza Bryant Village

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555286400000",
    "number": "1366438145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7201 WADE PARK AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44103",
            "telephone_number": "216-361-6141",
            "fax_number": "216-588-1982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7201 WADE PARK AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44103",
            "telephone_number": "216-361-6141",
            "fax_number": "216-588-1982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIZA BRYANT VILLAGE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ELIZA BRYANT VILLAGE",
        "enumeration_date": "2005-09-27",
        "last_updated": "2019-04-15",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "DANNY",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "216-361-6141",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD, LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "3660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0612822",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.