Provider Demographics
NPI:1396883591
Name:ST AUGUSTINE MANOR
Entity type:Organization
Organization Name:ST AUGUSTINE MANOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND 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 1:7801 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 1:7801 DETROIT AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102
Practice Address - Country:US
Practice Address - Phone:216-634-7400
Practice Address - Fax:216-634-7483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1971314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0891585Medicare ID - Type Unspecified
OH365883Medicare ID - Type Unspecified