Healthcare Provider Details

I. General information

NPI: 1659607455
Provider Name (Legal Business Name): JM CLEMENTE CO. LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 NILES RD SE
WARREN OH
44484-3276
US

IV. Provider business mailing address

3100 NILES RD SE
WARREN OH
44484-3276
US

V. Phone/Fax

Practice location:
  • Phone: 330-392-7069
  • Fax: 330-392-7071
Mailing address:
  • Phone: 330-392-7069
  • Fax: 330-392-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN MARK CLEMENTE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 330-392-7069