1043506173 NPI number — CUMMINGS, WALCOTT AND DAVID CORP

Table of content: (NPI 1043506173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043506173 NPI number — CUMMINGS, WALCOTT AND DAVID CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUMMINGS, WALCOTT AND DAVID CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LONGBROOK LOVING COTTAGE LIVING FACILITY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043506173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3240 E 116TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44120-3840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-224-1425
Provider Business Mailing Address Fax Number:
570-685-1343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20109 LONGBROOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENSVILLE HEIGHTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44128-2826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-906-4437
Provider Business Practice Location Address Fax Number:
570-685-1343
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CUMMINGS
Authorized Official First Name:
EULAH
Authorized Official Middle Name:
DARLENE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
216-224-1425

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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