Provider Demographics
NPI:1215388129
Name:ROSE-MARY, THE JOHANNA GRASSELLI REHABILITATION AND EDUCATION CENTER
Entity Type:Organization
Organization Name:ROSE-MARY, THE JOHANNA GRASSELLI REHABILITATION AND EDUCATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-481-4823
Mailing Address - Street 1:19350 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1425
Mailing Address - Country:US
Mailing Address - Phone:216-481-4154
Mailing Address - Fax:
Practice Address - Street 1:4383 AMMON ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121
Practice Address - Country:US
Practice Address - Phone:216-481-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities