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General NPI Number Information
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NPI Number | 1053309211
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Entity Type | Organization
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Legal Business Name | SISTERS OF ST. JOSEPH OF ST. MARK - MOUNT ST. JOSEPH
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 09/09/2014
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Provider Practice Location Address
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Address Line | 21800 CHARDON RD
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City | EUCLID
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State | OH
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Zip | 44117-2125
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Country | US
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Telephone | 216-531-7426
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Fax | 216-531-4033
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Provider Business Mailing Address
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Address Line | 21800 CHARDON RD
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City | EUCLID
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State | OH
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Zip | 44117-2125
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Country | US
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Telephone | 216-531-7426
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Fax | 216-531-4033
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SISTER MARY RAPHAEL GREGG
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Credential | RN., LNHA
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Telephone | 216-531-7426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 206
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License Number State | OH
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