Healthcare Provider Details

I. General information

NPI: 1104602978
Provider Name (Legal Business Name): MMS ADULT DAY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 09/06/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4536 WARNER RD
CLEVELAND OH
44105-6551
US

IV. Provider business mailing address

4536 WARNER RD
CLEVELAND OH
44105-6551
US

V. Phone/Fax

Practice location:
  • Phone: 216-232-6695
  • Fax:
Mailing address:
  • Phone: 216-232-6695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. PORSCHE L ALEXANDER
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 216-232-6695