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General NPI Number Information
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NPI Number | 1679511463
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Entity Type | Organization
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Legal Business Name | MARYMOUNT HOSPITAL INC
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 12300 MCCRACKEN ROAD
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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 | 216-581-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 BRECKSVILLE RD STE 20,ATTN: DPC RK2-7
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City | INDEPENDENCE
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State | OH
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Zip | 44131-5062
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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 | EXECUTIVE VP CHIEF FINANCE OFFICER
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Name | DENNIS LARAWAY
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Credential |
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Telephone | 216-445-1343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 1136
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License Number State | OH
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