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General NPI Number Information
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NPI Number | 1255298519
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Entity Type | Individual
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Provider Name | MARY KATHERINE BENNETT NHA, PCA
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Gender | Female
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Dates
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Enumeration Date | 01/08/2026
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 8389 DRAKE STATELINE RD NE
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City | BURGHILL
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State | OH
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Zip | 44404-9768
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Country | US
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Telephone | 330-720-2659
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Fax |
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Provider Business Mailing Address
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Address Line | 8389 DRAKE STATELINE RD NE
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City | BURGHILL
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State | OH
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Zip | 44404-9768
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Country | US
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Telephone | 330-720-2659
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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