=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467427518
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSITY HOSPITALS ST. JOHN MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2006
-----------------------------------------------------
Last Update Date | 04/29/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 29000 CENTER RIDGE RD
-----------------------------------------------------
City | WESTLAKE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44145-5293
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-835-8000
-----------------------------------------------------
Fax | 440-746-3405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 772930
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48277-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-746-3401
-----------------------------------------------------
Fax | 440-746-3405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, FP&A
-----------------------------------------------------
Name | ANTHONY SCHILLERO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-767-8141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------