MEDICARE: FIRST AND TWENTY FIVE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1164068540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST AND TWENTY FIVE LLC

Provider Business Mailing Address
First Line	:	1507 SAINT CLAIR AVE NE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2003
Country	:	US
Telephone Number	:	216-417-0047
Fax Number	:	216-916-4925

Provider Business Practice Location Address
First Line	:	1507 SAINT CLAIR AVE NE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2003
Country	:	US
Telephone Number	:	216-417-0047
Fax Number	:	216-916-4925

Authorized Official
Title or Position	:	OWNER
Name	:	MR. THEODORE GINN SR.
Credential	:
Telephone Number	:	216-417-0047

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	09/18/2024

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Directions to “FIRST AND TWENTY FIVE LLC ” Practice Location

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