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General NPI Number Information
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NPI Number | 1164245361
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Entity Type | Organization
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Legal Business Name | SAINT THERESE OF AVON LLC
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 35755 DETROIT RD
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City | AVON
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State | OH
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Zip | 44011-1689
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Country | US
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Telephone | 440-937-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 35755 DETROIT RD
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City | AVON
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State | OH
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Zip | 44011-1689
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. CAL M SHELANGOSKI
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Credential |
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Telephone | 952-283-2204
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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 |
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License Number State |
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