Provider Demographics
NPI:1194141622
Name:COMMUNITY HEALTHCARE PARTNER, LLC
Entity type:Organization
Organization Name:COMMUNITY HEALTHCARE PARTNER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIEZL
Authorized Official - Middle Name:YU
Authorized Official - Last Name:MALIBIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:440-709-6028
Mailing Address - Street 1:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092
Mailing Address - Country:US
Mailing Address - Phone:440-709-6028
Mailing Address - Fax:440-709-6303
Practice Address - Street 1:8386 RALEIGH PLACE
Practice Address - Street 2:
Practice Address - City:CONCORD TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-709-6028
Practice Address - Fax:440-709-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363L00000X
OH09561363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty