1689715047 NPI number — CLEVELAND COMMUNITY & HOME SUPPORT SERVICES INC

Table of content: (NPI 1689715047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689715047 NPI number — CLEVELAND COMMUNITY & HOME SUPPORT SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND COMMUNITY & HOME SUPPORT SERVICES 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:
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:
1689715047
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 N LAFAYETTE ST STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHELBY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28150-4450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-471-9755
Provider Business Mailing Address Fax Number:
704-480-7040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 N LAFAYETTE ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28150-4450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-471-9755
Provider Business Practice Location Address Fax Number:
704-480-7040
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BECK
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
EARWOOD
Authorized Official Title or Position:
SUPERVISOR
Authorized Official Telephone Number:
704-471-9755

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 900346612 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 246294416 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 238253841 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900462874 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 946025281 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 901258781 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 901273064 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 901245831 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 901259978 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 947067591 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 178566980 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 241179903 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 900156398 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 946667101 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 245259258 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 901263289 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 947956146 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 901259666 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 946851910 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 948100274 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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