MEDICARE: HUMILITY OF MARY HOUSING, INC.

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1457926867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMILITY OF MARY HOUSING, INC.

Provider Business Mailing Address
First Line	:	2251 FRONT ST STE 210
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-2578
Country	:	US
Telephone Number	:	234-525-6400
Fax Number	:	330-384-2144

Provider Business Practice Location Address
First Line	:	2251 FRONT ST STE 210
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-2578
Country	:	US
Telephone Number	:	234-525-6400
Fax Number	:	330-384-2144

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. FRED BERRY
Credential	:
Telephone Number	:	234-525-6400

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	05/26/2021

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