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General NPI Number Information
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NPI Number | 1205389319
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Entity Type | Organization
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Legal Business Name | SOAMAZIN AUTOMOTIVE
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Dates
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Enumeration Date | 07/26/2016
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 14115 MAPLEROW AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-6447
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Country | US
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Telephone | 216-358-3138
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Fax |
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Provider Business Mailing Address
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Address Line | 14115 MAPLEROW AVE MAPLEROW
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City | CLEVELAND
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State | OH
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Zip | 44105-6447
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Country | US
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Telephone | 216-358-3138
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Fax |
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Authorized Official
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Title or Position | LICENSED PRACTICAL NURSE
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Name | MS. MONICA A KINCAID
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Credential | LPN
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Telephone | 216-358-3138
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 141124
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License Number State | OH
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