Provider Demographics
NPI:1851085039
Name:MARYMOUNT HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MARYMOUNT HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:JAKOBOWITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-410-5283
Mailing Address - Street 1:3019 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3837
Mailing Address - Country:US
Mailing Address - Phone:917-410-5283
Mailing Address - Fax:
Practice Address - Street 1:5200 MARYMOUNT VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2973
Practice Address - Country:US
Practice Address - Phone:216-332-1100
Practice Address - Fax:216-332-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility