MEDICARE: EVERJOY ADULT FAMILY HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	189075	OH

General Provider Information

NPI Number	:	1043567654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERJOY ADULT FAMILY HOME

Provider Business Mailing Address
First Line	:	3813 GROSVENOR RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44118-2313
Country	:	US
Telephone Number	:	216-210-7373
Fax Number	:	216-321-0860

Provider Business Practice Location Address
First Line	:	3813 GROSVENOR RD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44118-2313
Country	:	US
Telephone Number	:	216-210-7373
Fax Number	:	216-321-0860

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ELAINE MCKELLAR
Credential	:
Telephone Number	:	216-210-7373

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	08/14/2012

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Directions to “EVERJOY ADULT FAMILY HOME ” Practice Location

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