Provider Demographics
NPI:1780840660
Name:THE VILLAGE AT MARYMOUNT
Entity type:Organization
Organization Name:THE VILLAGE AT MARYMOUNT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-587-8627
Mailing Address - Street 1:5100 MARYMOUNT VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2982
Mailing Address - Country:US
Mailing Address - Phone:216-332-1070
Mailing Address - Fax:216-332-1742
Practice Address - Street 1:5100 MARYMOUNT VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2982
Practice Address - Country:US
Practice Address - Phone:216-332-1070
Practice Address - Fax:216-332-1742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2207R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility