Provider Demographics
NPI:1376667014
Name:ST AUGUSTINE MANOR
Entity Type:Organization
Organization Name:ST AUGUSTINE MANOR
Other - Org Name:ST AUGUSTINE MANOR DOING BUSINESS AS HOLY FAMILY HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GAREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-634-7403
Mailing Address - Street 1:6707 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4517
Mailing Address - Country:US
Mailing Address - Phone:440-885-3100
Mailing Address - Fax:440-885-0644
Practice Address - Street 1:6707 STATE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-4517
Practice Address - Country:US
Practice Address - Phone:440-885-3100
Practice Address - Fax:440-885-0644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2691976Medicaid
OH361631Medicare ID - Type Unspecified