Healthcare Provider Details

I. General information

NPI: 1144841032
Provider Name (Legal Business Name): JERRY'S SOUTHERN HOME COOKING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 EUCLID AVE STE 150
CLEVELAND OH
44115-2430
US

IV. Provider business mailing address

2951 STEFFAN WOODS DR
TWINSBURG OH
44087-3342
US

V. Phone/Fax

Practice location:
  • Phone: 216-785-7530
  • Fax:
Mailing address:
  • Phone: 216-785-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State

VIII. Authorized Official

Name: JACQUELYN THOMPSON
Title or Position: OWNER
Credential:
Phone: 330-425-1217