Healthcare Provider Details

I. General information

NPI: 1134095284
Provider Name (Legal Business Name): RAJAH CERVENAK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 COLLEGE PARK DR APT H7
ELYRIA OH
44035-1561
US

IV. Provider business mailing address

180 COLLEGE PARK DR APT H7
ELYRIA OH
44035-1561
US

V. Phone/Fax

Practice location:
  • Phone: 440-610-1137
  • Fax:
Mailing address:
  • Phone: 440-610-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: