Healthcare Provider Details

I. General information

NPI: 1265022545
Provider Name (Legal Business Name): CITY OF REFUGE HOMES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 ARCHER RD
BEDFORD OH
44146-2978
US

IV. Provider business mailing address

840 ARCHER RD
BEDFORD OH
44146-2978
US

V. Phone/Fax

Practice location:
  • Phone: 216-990-1109
  • Fax:
Mailing address:
  • Phone: 216-990-1109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: BARBARA ANN BAYLOR
Title or Position: SECRETARY
Credential: NONE
Phone: 216-990-1109