=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043506173
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CUMMINGS, WALCOTT AND DAVID CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2011
-----------------------------------------------------
Last Update Date | 06/27/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20109 LONGBROOK RD
-----------------------------------------------------
City | WARRENSVILLE HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44128-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-906-4437
-----------------------------------------------------
Fax | 570-685-1343
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3240 E 116TH ST
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44120-3840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-224-1425
-----------------------------------------------------
Fax | 570-685-1343
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. EULAH DARLENE CUMMINGS
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 216-224-1425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------