1013531219 NPI number — MENTAL DISABILITY HEALTH & COMMUNITY RESIDENTIAL LLC

Table of content: MR. DANIEL PATRICK TOMLINSON NP (NPI 1255722104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013531219 NPI number — MENTAL DISABILITY HEALTH & COMMUNITY RESIDENTIAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MENTAL DISABILITY HEALTH & COMMUNITY RESIDENTIAL LLC
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1013531219
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3790 SHERWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH EUCLID
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44121-1940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-773-0532
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3790 SHERWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH EUCLID
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44121-1940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-773-0532
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
COLEMAN
Authorized Official First Name:
MORGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
AGENCY ADMINISTRATOR
Authorized Official Telephone Number:
216-773-0532

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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