Provider Demographics
NPI:1154938694
Name:MEDINA CREATIVE ACCESSIBILITY
Entity type:Organization
Organization Name:MEDINA CREATIVE ACCESSIBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPASQUALE-HAGERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-591-4434
Mailing Address - Street 1:224 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1980
Mailing Address - Country:US
Mailing Address - Phone:330-591-4434
Mailing Address - Fax:
Practice Address - Street 1:224 N COURT ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1980
Practice Address - Country:US
Practice Address - Phone:330-591-4434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDINA CREATIVE HOUSING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5211265Medicaid