Healthcare Provider Details

I. General information

NPI: 1114092814
Provider Name (Legal Business Name): CARNATION CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S ARCH AVE
ALLIANCE OH
44601-4202
US

IV. Provider business mailing address

1401 S ARCH AVE
ALLIANCE OH
44601-4202
US

V. Phone/Fax

Practice location:
  • Phone: 330-821-0201
  • Fax: 330-821-1924
Mailing address:
  • Phone: 330-821-0201
  • Fax: 330-821-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. RASARIO BAUTISTA
Title or Position: ADMINISTRATOR MGR
Credential:
Phone: 330-821-0201