MEDICARE: ST AUGUSTINE SERVICES CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	4654	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154586287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST AUGUSTINE SERVICES CORP

Provider Business Mailing Address
First Line	:	7801 DETROIT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2813
Country	:	US
Telephone Number	:	216-939-7609
Fax Number	:	216-634-7423

Provider Business Practice Location Address
First Line	:	7801 DETROIT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-2813
Country	:	US
Telephone Number	:	216-939-7609
Fax Number	:	216-634-7423

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. KATHIE A KAZDIN
Credential	:
Telephone Number	:	216-939-7609

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/29/2008

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Directions to “ST AUGUSTINE SERVICES CORP ” Practice Location

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