Healthcare Provider Details

I. General information

NPI: 1174127260
Provider Name (Legal Business Name): MR. CORTEZ JONES SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 WHITE POND DR STE 400
AKRON OH
44320-1185
US

IV. Provider business mailing address

470 WHITE POND DR STE 400
AKRON OH
44320-1185
US

V. Phone/Fax

Practice location:
  • Phone: 234-542-6230
  • Fax: 330-294-2025
Mailing address:
  • Phone: 234-542-6230
  • Fax: 330-294-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number7718054
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number7718054
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number7718054
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: