Provider Demographics
NPI:1215698634
Name:EMBASSY MERCER LLC
Entity type:Organization
Organization Name:EMBASSY MERCER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CICCONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-378-2050
Mailing Address - Street 1:25201 CHAGRIN BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5633
Mailing Address - Country:US
Mailing Address - Phone:216-378-2050
Mailing Address - Fax:
Practice Address - Street 1:7271 W MARKET ST
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-6608
Practice Address - Country:US
Practice Address - Phone:724-704-0039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA451510OtherPA DHS