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Organization
HOSPICE OF THE WESTERN RESERVE, INC.
Active
Organization
HOSPICE OF THE WESTERN RESERVE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY KAY TYLER (CHIEF QUALITY OFFICER)
(216) 383-3738
Entity
Organization
Contact information
Practice address
17876 SAINT CLAIR AVE, CLEVELAND, OH 44110-2602
(216) 383-3738
Mailing address
17876 SAINT CLAIR AVE, CLEVELAND, OH 44110-2602
(216) 383-3738
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
364S00000X
Clinical Nurse Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2619698
—
OH
01
—
9321651
MEDICARE PTAN
OH
Enumeration date
05/07/2008
Last updated
03/20/2026
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