Healthcare Provider Details

I. General information

NPI: 1245290618
Provider Name (Legal Business Name): EASTER SEALS NORTHERN OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929A E ROYALTON RD
BROADVIEW HTS OH
44147-2809
US

IV. Provider business mailing address

1929A E ROYALTON RD
BROADVIEW HTS OH
44147-2809
US

V. Phone/Fax

Practice location:
  • Phone: 440-838-0990
  • Fax: 440-838-8440
Mailing address:
  • Phone: 440-838-0990
  • Fax: 440-838-8440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. SHEILA M DUNN
Title or Position: PRESIDENT / CEO
Credential:
Phone: 440-838-0990