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General NPI Number Information
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NPI Number | 1619783552
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Entity Type | Individual
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Provider Name | MR. KEVIN R CRUMEDY SR.
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Gender | Male
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Dates
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Enumeration Date | 12/05/2024
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 4060 E 127TH ST
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City | CLEVELAND
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State | OH
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Zip | 44105-4738
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Country | US
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Telephone | 216-315-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 4060 E 127TH ST
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City | CLEVELAND
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State | OH
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Zip | 44105-4738
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Country | US
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Telephone | 216-315-3333
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | OH
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