1801952460 NPI number — MS. PENELOPE S KNIGHT L.I.S.W. AND A.C.S.W

Table of content: (NPI 1306055603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801952460 NPI number — MS. PENELOPE S KNIGHT L.I.S.W. AND A.C.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNIGHT
Provider First Name:
PENELOPE
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.I.S.W. AND A.C.S.W
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KNIGHT
Provider Other First Name:
PENELOPE
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.I.S.W. AND A.C.S.W
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1801952460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4405 MONTAGANO BLVD
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:
44121-3544
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-291-0681
Provider Business Mailing Address Fax Number:
216-291-0681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25901 EMERY RD
Provider Second Line Business Practice Location Address:
#108
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44128-5774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-429-3027
Provider Business Practice Location Address Fax Number:
216-291-0681
Provider Enumeration Date:
12/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I0006030 , 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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