Provider Demographics
NPI:1841525672
Name:VANTAGE PLACE INC
Entity type:Organization
Organization Name:VANTAGE PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:216-566-8707
Mailing Address - Street 1:5579 PEARL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-2555
Mailing Address - Country:US
Mailing Address - Phone:440-885-0100
Mailing Address - Fax:440-885-0221
Practice Address - Street 1:3105 FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-2946
Practice Address - Country:US
Practice Address - Phone:216-566-8707
Practice Address - Fax:216-566-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH55773104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness