Healthcare Provider Details

I. General information

NPI: 1992791933
Provider Name (Legal Business Name): CAGAJIB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5485 STATE ROUTE 128
CLEVES OH
45002-9439
US

IV. Provider business mailing address

5485 STATE ROUTE 128
CLEVES OH
45002-9439
US

V. Phone/Fax

Practice location:
  • Phone: 513-353-2900
  • Fax: 513-353-2988
Mailing address:
  • Phone: 513-353-2900
  • Fax: 513-353-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number6253
License Number StateOH

VIII. Authorized Official

Name: BERTHA HOBBS
Title or Position: PRESIDENT
Credential:
Phone: 513-353-2900