Healthcare Provider Details

I. General information

NPI: 1477678738
Provider Name (Legal Business Name): A BRAND NEW START ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 S GREEN RD
SOUTH EUCLID OH
44121-2818
US

IV. Provider business mailing address

533 S GREEN RD
SOUTH EUCLID OH
44121-2818
US

V. Phone/Fax

Practice location:
  • Phone: 440-840-2491
  • Fax: 440-878-5026
Mailing address:
  • Phone: 440-840-2491
  • Fax: 440-878-5026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number1586523
License Number StateOH

VIII. Authorized Official

Name: MRS. PATRICIA LYNN GORDON
Title or Position: EXECUTIVE DIRECTOROWNER
Credential: RN
Phone: 216-382-2222