Healthcare Provider Details

I. General information

NPI: 1053309211
Provider Name (Legal Business Name): SISTERS OF ST. JOSEPH OF ST. MARK - MOUNT ST. JOSEPH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21800 CHARDON RD
EUCLID OH
44117-2125
US

IV. Provider business mailing address

21800 CHARDON RD
EUCLID OH
44117-2125
US

V. Phone/Fax

Practice location:
  • Phone: 216-531-7426
  • Fax: 216-531-4033
Mailing address:
  • Phone: 216-531-7426
  • Fax: 216-531-4033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number206
License Number StateOH

VIII. Authorized Official

Name: SISTER MARY RAPHAEL GREGG
Title or Position: ADMINISTRATOR
Credential: RN., LNHA
Phone: 216-531-7426