Provider Demographics
NPI:1700238391
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:ROSE-MARY AMMON HOME
Other - Org Type:Doing Business As
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 RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-2803
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:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities