Provider Demographics
NPI:1710023759
Name:ST. MARY'S EDUCATIONAL INSTITUTE AT CINCINNATI
Entity Type:Organization
Organization Name:ST. MARY'S EDUCATIONAL INSTITUTE AT CINCINNATI
Other - Org Name:MOUNT NOTRE DAME HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISOWATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-821-7448
Mailing Address - Street 1:699 E COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3945
Mailing Address - Country:US
Mailing Address - Phone:513-821-7448
Mailing Address - Fax:513-821-7476
Practice Address - Street 1:699 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3945
Practice Address - Country:US
Practice Address - Phone:513-821-7448
Practice Address - Fax:513-821-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2311N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2267934Medicaid
OH2267934Medicaid