Healthcare Provider Details

I. General information

NPI: 1053616532
Provider Name (Legal Business Name): D.D.C.T. ENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24455 LAKESHORE BLVD APT 423
EUCLID OH
44123
US

IV. Provider business mailing address

24455 LAKE SHORE BLVD APT 423
EUCLID OH
44123-1247
US

V. Phone/Fax

Practice location:
  • Phone: 216-324-0638
  • Fax:
Mailing address:
  • Phone: 216-324-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. LATASHIA R. GLOVER
Title or Position: OWNER
Credential:
Phone: 216-324-0638