Healthcare Provider Details

I. General information

NPI: 1598968570
Provider Name (Legal Business Name): ELIZA JENNINGS SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10603 DETROIT AVE
CLEVELAND OH
44102-1647
US

IV. Provider business mailing address

10603 DETROIT AVE
CLEVELAND OH
44102-1647
US

V. Phone/Fax

Practice location:
  • Phone: 216-226-6090
  • Fax:
Mailing address:
  • Phone: 216-226-6090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: DENISE GANNON
Title or Position: VP OF CLINICAL SUPPORT
Credential: R.N.
Phone: 216-226-5000