Provider Demographics
NPI:1871849117
Name:MCGREGOR AT OVERLOOK
Entity type:Organization
Organization Name:MCGREGOR AT OVERLOOK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CONN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-851-8200
Mailing Address - Street 1:14900 PRIVATE DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3470
Mailing Address - Country:US
Mailing Address - Phone:216-851-8200
Mailing Address - Fax:216-851-6634
Practice Address - Street 1:14900 PRIVATE DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3470
Practice Address - Country:US
Practice Address - Phone:216-851-8200
Practice Address - Fax:216-851-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH361671OtherMEDICARE
OH0088548Medicaid
OH366383OtherMEDICARE PROVIDER #