1598911356 NPI number — ST. CLARENCE GEAC

Table of content: (NPI 1598911356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598911356 NPI number — ST. CLARENCE GEAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. CLARENCE GEAC
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:
EMERALD VILLAGE
Provider Other Organization Name Type Code:
3
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:
1598911356
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30344 LORAIN RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH OLMSTED
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-777-9300
Provider Business Mailing Address Fax Number:
440-777-9301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30344 LORAIN RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH OLMSTED
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-777-9300
Provider Business Practice Location Address Fax Number:
440-777-9301
Provider Enumeration Date:
08/13/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ZINGALE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
440-777-9300

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  2481R , 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)