Provider Demographics
NPI:1124117205
Name:GRACE HOSPITAL
Entity type:Organization
Organization Name:GRACE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, QUALITY MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHENTNIK
Authorized Official - Suffix:
Authorized Official - Credentials:JD, RHIT, CPHQ
Authorized Official - Phone:216-687-4014
Mailing Address - Street 1:2307 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3612
Mailing Address - Country:US
Mailing Address - Phone:216-687-4014
Mailing Address - Fax:216-687-4027
Practice Address - Street 1:2307 W 14TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3612
Practice Address - Country:US
Practice Address - Phone:216-687-4014
Practice Address - Fax:216-687-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3337400Medicaid
OH362015Medicare ID - Type Unspecified