=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710242029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARAH'S CIRCLE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2012
-----------------------------------------------------
Last Update Date | 07/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 S MAIN ST
-----------------------------------------------------
City | CHAGRIN FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44022-3264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-952-0783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9820 WHISPER WOOD CIR
-----------------------------------------------------
City | CHAGRIN FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44023-5117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-952-0783
-----------------------------------------------------
Fax | 440-708-1774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | EILEEN M PAPPALARDO
-----------------------------------------------------
Credential | PC, ATR-BC
-----------------------------------------------------
Telephone | 216-952-0783
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | C1100164
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------