MEDICARE: THE VILLAGE AT MARYMOUNT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	2207R	OH

General Provider Information

NPI Number	:	1780840660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE VILLAGE AT MARYMOUNT

Provider Business Mailing Address
First Line	:	5100 MARYMOUNT VILLAGE DR
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-2982
Country	:	US
Telephone Number	:	216-332-1070
Fax Number	:	216-332-1742

Provider Business Practice Location Address
First Line	:	5100 MARYMOUNT VILLAGE DR
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-2982
Country	:	US
Telephone Number	:	216-332-1070
Fax Number	:	216-332-1742

Authorized Official
Title or Position	:	CHIEF OPERATING OFFICER
Name	:	MR. JEFFRY A MYERS
Credential	:
Telephone Number	:	216-587-8627

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	07/31/2008

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Directions to “THE VILLAGE AT MARYMOUNT ” Practice Location

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