1902866908 NPI number — JEWISH FAMILY SERVICE ASSOCIATION

Table of content: ANGELA MAIRELY DE LA CRUZ NAVA (NPI 1881298644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902866908 NPI number — JEWISH FAMILY SERVICE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEWISH FAMILY SERVICE ASSOCIATION
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:
1902866908
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3659 GREEN RD
Provider Second Line Business Mailing Address:
PDC BUILDING SUITE 316
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-378-8663
Provider Business Mailing Address Fax Number:
216-378-8662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3659 GREEN ROAD
Provider Second Line Business Practice Location Address:
PDC BUILDING SUITE 316
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-5727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-378-8663
Provider Business Practice Location Address Fax Number:
216-378-8662
Provider Enumeration Date:
03/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEPHAN
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR DIRECTOR OF CLIENT SERVICES
Authorized Official Telephone Number:
216-504-6421

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2230544 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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