# EMBASSY MERCER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Lakes at Jefferson
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215698634
- **Authorized official:** NICHOLAS CICCONE (COMPLIANCE OFFICER)
- **Authorized official phone:** (216) 378-2050

## Contact information

- **Practice address:** 7271 W MARKET ST, MERCER, PA 16137-6608
- **Practice address phone:** (724) 704-0039
- **Mailing address:** 25201 CHAGRIN BLVD STE 190, BEACHWOOD, OH 44122-5633
- **Mailing address phone:** (216) 378-2050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 01/07/2022
- **Last updated:** 01/07/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 451510 | PA DHS | PA |