Provider Demographics
NPI:1528465077
Name:GARDENSOFWESTERNRESERVEHOSPICELLC
Entity type:Organization
Organization Name:GARDENSOFWESTERNRESERVEHOSPICELLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PIEKARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-289-1447
Mailing Address - Street 1:3792 STATE RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-2640
Mailing Address - Country:US
Mailing Address - Phone:216-916-1110
Mailing Address - Fax:234-678-0753
Practice Address - Street 1:3792 STATE RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-2640
Practice Address - Country:US
Practice Address - Phone:216-916-1110
Practice Address - Fax:234-678-0753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-28
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0234HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based