Healthcare Provider Details

I. General information

NPI: 1306419346
Provider Name (Legal Business Name): MED CARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 LORAIN AVE
CLEVELAND OH
44102-4897
US

IV. Provider business mailing address

9201 LORAIN AVE
CLEVELAND OH
44102-4897
US

V. Phone/Fax

Practice location:
  • Phone: 216-658-1615
  • Fax:
Mailing address:
  • Phone: 216-658-1615
  • Fax: 440-345-5151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MISS JESSICA LI
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-987-6098