Healthcare Provider Details

I. General information

NPI: 1164068540
Provider Name (Legal Business Name): FIRST AND TWENTY FIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 SAINT CLAIR AVE NE
CLEVELAND OH
44114-2003
US

IV. Provider business mailing address

1507 SAINT CLAIR AVE NE
CLEVELAND OH
44114-2003
US

V. Phone/Fax

Practice location:
  • Phone: 216-417-0047
  • Fax: 216-916-4925
Mailing address:
  • Phone: 216-417-0047
  • Fax: 216-916-4925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. THEODORE GINN SR.
Title or Position: OWNER
Credential:
Phone: 216-417-0047