Healthcare Provider Details

I. General information

NPI: 1649046988
Provider Name (Legal Business Name): INEZ PLACE ADULT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10916 CHURCHILL AVE
CLEVELAND OH
44106-1213
US

IV. Provider business mailing address

20040 RAYMOND ST
MAPLE HEIGHTS OH
44137-1826
US

V. Phone/Fax

Practice location:
  • Phone: 216-417-7178
  • Fax:
Mailing address:
  • Phone: 216-417-7178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State

VIII. Authorized Official

Name: KAREEMAH ROSE
Title or Position: OPERATOR
Credential:
Phone: 216-417-7178