Healthcare Provider Details

I. General information

NPI: 1912512021
Provider Name (Legal Business Name): METZENBAUM SHELTERED INDUSTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8090 CEDAR RD
CHESTERLAND OH
44026-3465
US

IV. Provider business mailing address

8090 CEDAR RD
CHESTERLAND OH
44026-3465
US

V. Phone/Fax

Practice location:
  • Phone: 440-729-1919
  • Fax: 440-729-1910
Mailing address:
  • Phone: 440-729-1919
  • Fax: 440-729-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES GRONER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 330-272-2515