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Organization
OLD SCHOOL LLC
Active
Organization
OLD SCHOOL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN J. SMITH (DIRECTOR/OWNER)
(216) 407-0437
Entity
Organization
Contact information
Practice address
17400 NORTHWOOD AVE, LAKEWOOD, OH 44107-2210
(216) 403-8640
(216) 862-5143
Mailing address
2109 WOOSTER RD, ROCKY RIVER, OH 44116-2674
(216) 407-0437
(216) 862-5143
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
101YA0400X
OH
Other
Enumeration date
03/04/2015
Last updated
03/04/2015
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