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General NPI Number Information
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NPI Number | 1073534210
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Entity Type | Organization
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Legal Business Name | VILLAGE AT MARYMOUNT
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 5300 MARYMOUNT VILLAGE DRIVE
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-2938
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Country | US
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Telephone | 216-587-8627
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Fax | 216-587-8967
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Provider Business Mailing Address
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Address Line | 5300 MARYMOUNT VILLAGE DRIVE
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-2914
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Country | US
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Telephone | 216-587-8627
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Fax | 216-587-8967
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. JEFFRY A MYERS
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Credential |
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Telephone | 216-587-8627
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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 | 2295N
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License Number State | OH
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