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NPI Code Detail

MEDICARE: ELIZA JENNINGS SERVICES CORPORATION

MEDICARE: ELIZA JENNINGS SERVICES CORPORATION
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
1261QA0600XAdult Day Care Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598968570
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELIZA JENNINGS SERVICES CORPORATION
Provider Business Mailing Address
First Line : 10603 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-1647
Country : US
Telephone Number : 216-226-6090
Fax Number :
Provider Business Practice Location Address
First Line : 10603 DETROIT AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44102-1647
Country : US
Telephone Number : 216-226-6090
Fax Number :
Authorized Official
Title or Position : VP OF CLINICAL SUPPORT
Name : DENISE GANNON
Credential : R.N.
Telephone Number : 216-226-5000
Provider Enumeration Date : 06/07/2007
Last Update Date : 08/22/2020

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