Provider Demographics
NPI:1700277126
Name:MONTEFIORE HOME
Entity type:Organization
Organization Name:MONTEFIORE HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO & VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-910-2640
Mailing Address - Street 1:ONE DAVID N MYERS PARKWAY
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1162
Mailing Address - Country:US
Mailing Address - Phone:216-360-9080
Mailing Address - Fax:
Practice Address - Street 1:ONE DAVID N MYERS PARKWAY
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1162
Practice Address - Country:US
Practice Address - Phone:216-360-9080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTEFIORE HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty