1053309211 NPI number — SISTERS OF ST. JOSEPH OF ST. MARK - MOUNT ST. JOSEPH

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053309211 NPI number — SISTERS OF ST. JOSEPH OF ST. MARK - MOUNT ST. JOSEPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SISTERS OF ST. JOSEPH OF ST. MARK - MOUNT ST. JOSEPH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MOUNT ST. JOSEPH REHAB CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053309211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21800 CHARDON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUCLID
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44117-2125
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-531-7426
Provider Business Mailing Address Fax Number:
216-531-4033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21800 CHARDON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUCLID
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44117-2125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-531-7426
Provider Business Practice Location Address Fax Number:
216-531-4033
Provider Enumeration Date:
10/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GREGG
Authorized Official First Name:
SISTER MARY
Authorized Official Middle Name:
RAPHAEL
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
216-531-7426

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  206 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 365487 . This is a "MEDICARE PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".




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