Healthcare Provider Details

I. General information

NPI: 1033944731
Provider Name (Legal Business Name): CARE FOR ALL COMMUNITY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2024
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33140 AURORA RD
SOLON OH
44139-3617
US

IV. Provider business mailing address

1056 MEREDITH ST
KENT OH
44240-3364
US

V. Phone/Fax

Practice location:
  • Phone: 330-503-8802
  • Fax:
Mailing address:
  • Phone: 330-503-8802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. QUINCY ALAN JOHNSON
Title or Position: EMPLOYEE
Credential: YOUTH MENTAL HEALTH
Phone: 330-503-8802