=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912512021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | METZENBAUM SHELTERED INDUSTRIES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2020
-----------------------------------------------------
Last Update Date | 09/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8090 CEDAR RD
-----------------------------------------------------
City | CHESTERLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44026-3465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-729-1919
-----------------------------------------------------
Fax | 440-729-1910
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8090 CEDAR RD
-----------------------------------------------------
City | CHESTERLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44026-3465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-729-1919
-----------------------------------------------------
Fax | 440-729-1910
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. JAMES GRONER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-272-2515
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------