Healthcare Provider Details

I. General information

NPI: 1194141622
Provider Name (Legal Business Name): COMMUNITY HEALTHCARE PARTNER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8386 RALEIGH PLACE
CONCORD TOWNSHIP OH
44077
US

IV. Provider business mailing address

PO BOX 313
WICKLIFFE OH
44092
US

V. Phone/Fax

Practice location:
  • Phone: 440-709-6028
  • Fax: 440-709-6303
Mailing address:
  • Phone: 440-709-6028
  • Fax: 440-709-6303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number09561
License Number StateOH

VIII. Authorized Official

Name: LIEZL YU MALIBIRAN
Title or Position: PRESIDENT
Credential: CNP
Phone: 440-709-6028