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General NPI Number Information
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NPI Number | 1053670240
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Entity Type | Organization
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Legal Business Name | FOR OUR CHILDREN'S ULTIMATE SUCCESS
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Dates
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Enumeration Date | 05/09/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 3530 WARRENSVILLE CENTER RD 101D
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-5278
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Country | US
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Telephone | 216-254-4143
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Fax |
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Provider Business Mailing Address
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Address Line | 3530 WARRENSVILLE CENTER RD 101D
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-5278
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Country | US
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Telephone | 216-254-4143
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KARMEAN FOWLKES
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Credential |
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Telephone | 216-254-4143
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 1459780
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License Number State | OH
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Legacy Identifiers
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Identifier #1
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Identifier Code | 0059248
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Identifier Type | MEDICAID
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Identifier State | OH
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 0059248
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Identifier Type | MEDICAID
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Identifier State | OH
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Identifier Issuer |
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