1245290618 NPI number — EASTER SEALS NORTHERN OHIO

Table of content: (NPI 1245290618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245290618 NPI number — EASTER SEALS NORTHERN OHIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS NORTHERN OHIO
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:
1245290618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1929A E ROYALTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROADVIEW HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44147-2809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-838-0990
Provider Business Mailing Address Fax Number:
440-838-8440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1929A E ROYALTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROADVIEW HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44147-2809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-838-0990
Provider Business Practice Location Address Fax Number:
440-838-8440
Provider Enumeration Date:
03/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT / CEO
Authorized Official Telephone Number:
440-838-0990

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: 0849916 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7700349 . This is a "MEDICAID WAIVER HOMECARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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