1578621157 NPI number — MRS. JACQUELINE FRANCIS HOLLCRAFT PAC

Table of content: MRS. JACQUELINE FRANCIS HOLLCRAFT PAC (NPI 1578621157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578621157 NPI number — MRS. JACQUELINE FRANCIS HOLLCRAFT PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLCRAFT
Provider First Name:
JACQUELINE
Provider Middle Name:
FRANCIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCHNEIDER
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
FRANCIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578621157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5800 LANDERBROOK DR STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAYFIELD HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44124-6510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-443-0423
Provider Business Mailing Address Fax Number:
440-443-0414

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4124 MUNSON ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44718-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-443-0330
Provider Business Practice Location Address Fax Number:
234-410-7549
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA16968 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 50.006278RX , 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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