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General NPI Number Information
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NPI Number | 1346328994
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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 | 11/01/2006
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Last Update Date | 12/19/2014
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Provider Practice Location Address
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Address Line | 5200 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 |
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Provider Business Mailing Address
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Address Line | 5200 MARYMOUNT VILLAGE DRIVE
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City | GARFIELD HTS.
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State | OH
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Zip | 44125
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Country | US
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Telephone | 216-587-8627
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Fax | 216-332-1619
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Authorized Official
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Title or Position | C.O.O.
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Name | MR. JEFFRY A. MYERS
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Credential | CPA
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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 | 2463N
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License Number State | OH
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