MEDICARE: ETHEL J. ROLDAN CENTER FOR CULTURAL AWARENESS INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	252Y00000X	Early Intervention Provider Agency
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1841947645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETHEL J. ROLDAN CENTER FOR CULTURAL AWARENESS INC.

Provider Business Mailing Address
First Line	:	1610 CLEVELAND RD STE 102
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-4374
Country	:	US
Telephone Number	:	419-621-1117
Fax Number	:	419-621-1117

Provider Business Practice Location Address
First Line	:	1610 CLEVELAND RD STE 102
Second Line	:
City	:	SANDUSKY
State	:	OH
Zip	:	44870-4374
Country	:	US
Telephone Number	:	419-621-1117
Fax Number	:	419-621-1117

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. RACQUEL PACE
Credential	:
Telephone Number	:	419-621-1117

Provider Enumeration Date	:	03/02/2022
Last Update Date	:	03/02/2022

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