Provider Demographics
NPI:1528248820
Name:MENORAH PARK CENTER FOR SENIOR LIVING
Entity type:Organization
Organization Name:MENORAH PARK CENTER FOR SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, HOSPICE AND PALLIATIVE CARE
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIKOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-563-6291
Mailing Address - Street 1:27100 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1109
Mailing Address - Country:US
Mailing Address - Phone:216-831-6500
Mailing Address - Fax:216-896-1100
Practice Address - Street 1:27100 CEDAR RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1109
Practice Address - Country:US
Practice Address - Phone:216-831-6500
Practice Address - Fax:216-896-1100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENORAH PARK CENTER FOR SENIOR LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-05
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2891901Medicaid