Healthcare Provider Details

I. General information

NPI: 1932705902
Provider Name (Legal Business Name): NIGHTINGALE VESPA ADAPTED ADVANTAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37229 EUCLID AVE
WILLOUGHBY OH
44094-5661
US

IV. Provider business mailing address

9759 CAMPTON RIDGE DR
CHARDON OH
44024-8661
US

V. Phone/Fax

Practice location:
  • Phone: 440-487-5649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: JOHN VESPA
Title or Position: CEO
Credential:
Phone: 440-487-5649