Organization
GOVERNOR'S VILLAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE KATHLEEN GORMAN (EXECUTIVE DIRECTOR)
(440) 449-8788
Entity
Organization
Contact information
Practice address
280 N COMMONS BLVD, MAYFIELD VILLAGE, OH 44143-1592
(440) 449-8788
Mailing address
280 N COMMONS BLVD, MAYFIELD VILLAGE, OH 44143-1592
(440) 449-8788
(440) 442-8648
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
RCF2332R
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2818455
—
OH
Enumeration date
07/13/2009
Last updated
07/13/2009
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