Healthcare Provider Details

I. General information

NPI: 1932888013
Provider Name (Legal Business Name): FORGOTTEN FACES COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 E 146TH ST
CLEVELAND OH
44110-3316
US

IV. Provider business mailing address

1034 E 146TH ST
CLEVELAND OH
44110-3316
US

V. Phone/Fax

Practice location:
  • Phone: 216-609-6657
  • Fax:
Mailing address:
  • Phone: 216-609-6657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: LAKEYTA GILCREASE
Title or Position: CEO
Credential:
Phone: 216-609-6657