1134441595 NPI number — CHERUBIM CARING LLC

Table of content: (NPI 1134441595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134441595 NPI number — CHERUBIM CARING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHERUBIM CARING 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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134441595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7445
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44306-0445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-573-1840
Provider Business Mailing Address Fax Number:
330-956-3912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
775 KIPLING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44306-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-573-1840
Provider Business Practice Location Address Fax Number:
330-956-3912
Provider Enumeration Date:
02/25/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCCLENDON
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER/LPN
Authorized Official Telephone Number:
330-573-1840

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  PN. 095799 IV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251J00000X , with the licence number: PN. 095799 IV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2859152 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1407003676 . This is a "NPPES" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".