Provider Demographics
NPI:1033599105
Name:ST AUGUSTINE MANOR
Entity Type:Organization
Organization Name:ST AUGUSTINE MANOR
Other - Org Name:ST AUGUSTINE MANOR PROFESSIONAL SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-634-7555
Mailing Address - Street 1:7801 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-2813
Mailing Address - Country:US
Mailing Address - Phone:216-634-7400
Mailing Address - Fax:216-634-7483
Practice Address - Street 1:7801 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2813
Practice Address - Country:US
Practice Address - Phone:216-634-7400
Practice Address - Fax:216-634-7483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST AUGUSTINE MANOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty