1750686630 NPI number — GERIATRIC HEALTH EXCELLENCE LLC

Table of content: (NPI 1750686630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750686630 NPI number — GERIATRIC HEALTH EXCELLENCE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERIATRIC HEALTH EXCELLENCE 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:
6
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:
1750686630
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 77043
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44194-7043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-472-2730
Provider Business Mailing Address Fax Number:
216-472-2740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11201 SHAKER BLVD
Provider Second Line Business Practice Location Address:
SUITE 328
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44104-3869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-881-5055
Provider Business Practice Location Address Fax Number:
216-881-5855
Provider Enumeration Date:
01/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PIERCE
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
NP / OWNER
Authorized Official Telephone Number:
216-881-5055

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  COA11665-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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