Healthcare Provider Details

I. General information

NPI: 1346268166
Provider Name (Legal Business Name): ST. MARY OF THE WOODS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35755 DETROIT RD
AVON OH
44011-1689
US

IV. Provider business mailing address

35755 DETROIT RD
AVON OH
44011-1689
US

V. Phone/Fax

Practice location:
  • Phone: 440-937-3111
  • Fax: 440-937-2738
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2439N
License Number StateOH

VIII. Authorized Official

Name: MR. MARK BAILEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 440-937-3111