Healthcare Provider Details

I. General information

NPI: 1902123706
Provider Name (Legal Business Name): CARMEN'S ADULT DAYCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 FAIRHILL RD
CLEVELAND OH
44120-1058
US

IV. Provider business mailing address

12200 FAIRHILL RD
CLEVELAND OH
44120-1058
US

V. Phone/Fax

Practice location:
  • Phone: 216-325-7710
  • Fax:
Mailing address:
  • Phone: 216-325-7710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1928087
License Number StateOH

VIII. Authorized Official

Name: MRS. HENRIETTA BYERS
Title or Position: ADMINISTRATOR
Credential:
Phone: 216-325-7710