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General NPI Number Information
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NPI Number | 1649046988
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Entity Type | Organization
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Legal Business Name | INEZ PLACE ADULT CARE
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 10916 CHURCHILL AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1213
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Country | US
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Telephone | 216-417-7178
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Fax |
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Provider Business Mailing Address
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Address Line | 20040 RAYMOND ST
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137-1826
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Country | US
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Telephone | 216-417-7178
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Fax |
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Authorized Official
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Title or Position | OPERATOR
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Name | KAREEMAH ROSE
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Credential |
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Telephone | 216-417-7178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 177F00000X
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Taxonomy Name | Lodging Provider
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License Number |
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License Number State |
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