Healthcare Provider Details

I. General information

NPI: 1245809904
Provider Name (Legal Business Name): EASTER SEALS NORTHERN OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 CROGHAN ST
FREMONT OH
43420-2762
US

IV. Provider business mailing address

1212 PORTAGE TRL
CUYAHOGA FALLS OH
44223-2128
US

V. Phone/Fax

Practice location:
  • Phone: 800-589-6834
  • Fax:
Mailing address:
  • Phone: 234-417-0250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN E HOLLY
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 234-417-0250