Healthcare Provider Details

I. General information

NPI: 1457628083
Provider Name (Legal Business Name): WESTERN RESERVE AREA AGENCY ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 13TH ST STE 114
CLEVELAND OH
44114-3285
US

IV. Provider business mailing address

1700 E 13TH ST STE 114
CLEVELAND OH
44114-3285
US

V. Phone/Fax

Practice location:
  • Phone: 216-621-0303
  • Fax: 216-621-7171
Mailing address:
  • Phone: 216-621-0303
  • Fax: 216-621-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER T. HALL
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 216-621-0303