1861490245 NPI number — ATHENIAN ASSISTED LIVING CENTER

Table of content: DR. RACHAEL MORIN RAYBURN D.O. (NPI 1558611665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861490245 NPI number — ATHENIAN ASSISTED LIVING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATHENIAN ASSISTED LIVING CENTER
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:
1861490245
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1026 PEARL RD
Provider Second Line Business Mailing Address:
SUITE #5
Provider Business Mailing Address City Name:
BRUNSWICK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44212-2516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-225-8054
Provider Business Mailing Address Fax Number:
330-225-9094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12799 DOULA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH ROYALTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44133-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-877-1900
Provider Business Practice Location Address Fax Number:
440-877-1905
Provider Enumeration Date:
07/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GAITANAROS
Authorized Official First Name:
DOULA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-225-8054

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  3060 , 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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