Provider Demographics
NPI:1578644316
Name:ST AUGUSTINE MANOR
Entity Type:Organization
Organization Name:ST AUGUSTINE MANOR
Other - Org Name:HOLY FAMILY HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
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:216-634-7400
Mailing Address - Street 1:7801 DETROIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102
Mailing Address - Country:US
Mailing Address - Phone:216-634-7400
Mailing Address - Fax:216-634-7483
Practice Address - Street 1:6707 STATE ROAD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134
Practice Address - Country:US
Practice Address - Phone:440-888-7722
Practice Address - Fax:440-866-6040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. AUGUSTINE MANOR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1497059251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2614657Medicaid
OH368115Medicare Oscar/Certification