Provider Demographics
NPI:1083637912
Name:ST VINCENT CHARITY MEDICAL CENTER
Entity Type:Organization
Organization Name:ST VINCENT CHARITY MEDICAL CENTER
Other - Org Name:ST VINCENT CHARITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP SCHS/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUSNACZYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-436-4653
Mailing Address - Street 1:6935 TREELINE DR STE J
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-3393
Mailing Address - Country:US
Mailing Address - Phone:440-746-3401
Mailing Address - Fax:440-746-3405
Practice Address - Street 1:2351 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3111
Practice Address - Country:US
Practice Address - Phone:216-861-6200
Practice Address - Fax:440-746-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2012-08-17
Deactivation Date:2008-12-16
Deactivation Code:
Reactivation Date:2012-08-17
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0818OtherMACSIS
OH0818OtherMACSIS