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General NPI Number Information
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NPI Number | 1154586287
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Entity Type | Organization
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Legal Business Name | ST AUGUSTINE SERVICES CORP
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 7801 DETROIT AVE
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City | CLEVELAND
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State | OH
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Zip | 44102-2813
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Country | US
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Telephone | 216-939-7609
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Fax | 216-634-7423
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Provider Business Mailing Address
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Address Line | 7801 DETROIT AVE
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City | CLEVELAND
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State | OH
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Zip | 44102-2813
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Country | US
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Telephone | 216-939-7609
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Fax | 216-634-7423
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. KATHIE A KAZDIN
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Credential |
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Telephone | 216-939-7609
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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 | 4654
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License Number State | OH
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