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NPI Code Detail

MEDICARE: GERIATRIC SPECIALTY CARE LLC

MEDICARE: GERIATRIC SPECIALTY CARE LLC
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
1363LG0600XGerontology Nurse PractitionerCOA08023-NPOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154574630
Entity Type Code : Organization
Provider Name (Legal Business Name) : GERIATRIC SPECIALTY CARE LLC
Provider Business Mailing Address
First Line : PO BOX 670486
Second Line :
City : NORTHFIELD
State : OH
Zip : 44067-0486
Country : US
Telephone Number : 440-571-0025
Fax Number : 949-695-3229
Provider Business Practice Location Address
First Line : 100 BROOKMONT RD
Second Line :
City : AKRON
State : OH
Zip : 44333-9207
Country : US
Telephone Number : 440-571-0025
Fax Number : 949-695-3229
Authorized Official
Title or Position : OWNER
Name : ALICIA WOLF
Credential : NP
Telephone Number : 440-666-6457
Provider Enumeration Date : 10/29/2008
Last Update Date : 04/07/2026

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Directions to “GERIATRIC SPECIALTY CARE LLC ” Practice Location

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