Provider Demographics
NPI:1194279158
Name:AHC OF LANDERHAVEN LLC
Entity type:Organization
Organization Name:AHC OF LANDERHAVEN LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OXNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-447-9860
Mailing Address - Street 1:2108 LANDER RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4152
Mailing Address - Country:US
Mailing Address - Phone:440-443-0345
Mailing Address - Fax:
Practice Address - Street 1:2108 LANDER RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-4137
Practice Address - Country:US
Practice Address - Phone:614-416-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW AHC HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-08
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility