Palm Crest West, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3915 Issued in OH

Legal business name

PALM CREST WEST, INC.

Practice address

221 West Ave
Elyria, OH 44035-5309

Phone

(440) 322-2525

Fax

(440) 284-1051

NPI assigned

Jun 8, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kevin Rotenberry, CPA

Title

Cfo

Phone

(440) 239-4300

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508860586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 WEST AVE",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440355309",
            "telephone_number": "440-322-2525",
            "fax_number": "440-284-1051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 WEST AVE",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440355309",
            "telephone_number": "440-322-2525",
            "fax_number": "440-284-1051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALM CREST WEST, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROTENBERRY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "440-239-4300",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "3915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0357251",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.