MEDICARE: ALL OF MY CHILDREN

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	385HR2065X	Child Physical Disabilities Respite Care	PN146071	OH
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care	PN146071	OH

General Provider Information

NPI Number	:	1134509425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALL OF MY CHILDREN

Provider Business Mailing Address
First Line	:	516 E 124TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1809
Country	:	US
Telephone Number	:	216-322-1852
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 E 124TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1809
Country	:	US
Telephone Number	:	216-322-1852
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA MARIE PHILLIPS
Credential	:	LPN
Telephone Number	:	216-322-1852

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	06/02/2015

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Directions to “ALL OF MY CHILDREN ” Practice Location

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