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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