1104005016 NPI number — 840 SHERMAN HEALTHCARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104005016 NPI number — 840 SHERMAN HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
840 SHERMAN HEALTHCARE, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1104005016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25000 COUNTRY CLUB BLVD
Provider Second Line Business Mailing Address:
SUITE 255
Provider Business Mailing Address City Name:
NORTH OLMSTED
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44070-5344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-614-0160
Provider Business Mailing Address Fax Number:
440-614-0168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 SHERMAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44041-9101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-614-0160
Provider Business Practice Location Address Fax Number:
440-614-0168
Provider Enumeration Date:
10/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLLERAN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-614-0160

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2902470 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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