Provider Demographics
NPI:1194328377
Name:DORCHOCK, CARI
Entity type:Individual
Prefix:
First Name:CARI
Middle Name:
Last Name:DORCHOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 SAINT LAWRENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-1300
Mailing Address - Country:US
Mailing Address - Phone:440-829-8145
Mailing Address - Fax:
Practice Address - Street 1:296 SAINT LAWRENCE BLVD
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-1300
Practice Address - Country:US
Practice Address - Phone:440-829-8145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM43013573747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM4301357Medicaid