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General NPI Number Information
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NPI Number | 1851085039
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Entity Type | Organization
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Legal Business Name | MARYMOUNT HEALTHCARE, LLC
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 5200 MARYMOUNT VILLAGE DR
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-2973
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Country | US
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Telephone | 216-332-1100
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Fax | 216-332-1619
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Provider Business Mailing Address
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Address Line | 3019 AVENUE J
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City | BROOKLYN
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State | NY
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Zip | 11210-3837
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Country | US
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Telephone | 917-410-5283
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Fax |
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Authorized Official
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Title or Position | CAO
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Name | DAVID JAKOBOWITCH
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Credential |
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Telephone | 917-410-5283
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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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