1740349208 NPI number — ROSE-MARY, THE JOHANNA GRASSELLI REHABILITATION AND EDUCATION CENTER

Table of content: (NPI 1740349208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740349208 NPI number — ROSE-MARY, THE JOHANNA GRASSELLI REHABILITATION AND EDUCATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSE-MARY, THE JOHANNA GRASSELLI REHABILITATION AND EDUCATION CENTER
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:
Provider Other Organization Name Type Code:
6
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:
1740349208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 S MARGINAL RD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44103-1009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-481-4823
Provider Business Mailing Address Fax Number:
216-481-4154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2346 W 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44113-3613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-481-4823
Provider Business Practice Location Address Fax Number:
216-481-4154
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KERMAN
Authorized Official First Name:
GINA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
216-481-4823

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0318794 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com