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General NPI Number Information
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NPI Number | 1821328345
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Entity Type | Organization
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Legal Business Name | OUR COMMUNITY ADULT CARE
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 9606 MILES AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-6122
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Country | US
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Telephone | 216-820-8860
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Fax |
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Provider Business Mailing Address
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Address Line | 9606 MILES AVE
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City | CLEVELAND
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State | OH
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Zip | 44105-6122
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Country | US
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Telephone | 216-820-8860
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Fax |
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Authorized Official
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Title or Position | OWNER/PROPRIETOR
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Name | CHAUN'DREA NICOLE CLARK
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Credential | STNA
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Telephone | 216-820-8860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | OH
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