1821429986 NPI number — NORTHERN OHIO CARE GIVERS

Table of content: (NPI 1821429986)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821429986 NPI number — NORTHERN OHIO CARE GIVERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN OHIO CARE GIVERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMFORT KEEPERS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821429986
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 WHITTLESEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWALK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44857-1450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
567-424-6773
Provider Business Mailing Address Fax Number:
567-424-6783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77 WHITTLESEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44857-1450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
567-424-6773
Provider Business Practice Location Address Fax Number:
567-424-6783
Provider Enumeration Date:
11/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GREGORY
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
567-424-6773

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36-8471 . This is a "CCN 36-8471" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3085521 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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