Organization
EMBASSY NEWARK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS CICCONE (CHIEF COMPLIANCE OFFICER)
(570) 885-5841
Entity
Organization
Contact information
Practice address
75 MCMILLEN DR, NEWARK, OH 43055-1808
(740) 344-0357
Mailing address
25201 CHAGRIN BLVD STE 190, BEACHWOOD, OH 44122-5633
(216) 378-2050
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1706N
LICENSURE
OH
Enumeration date
08/27/2021
Last updated
08/27/2021
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