Healthcare Provider Details

I. General information

NPI: 1073935961
Provider Name (Legal Business Name): PASSERELL ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 PEARL RD. SUITE #17
MEDINA OH
44256
US

IV. Provider business mailing address

1114 N COURT ST #230
MEDINA OH
44256-1579
US

V. Phone/Fax

Practice location:
  • Phone: 330-722-6444
  • Fax: 330-722-4334
Mailing address:
  • Phone: 330-722-6444
  • Fax: 330-722-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ANN M. PASSERELL
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 330-722-6444