Provider Demographics
NPI:1194784801
Name:MULTICARE HEALTH & EDUCATIONAL SERVICES INC.
Entity type:Organization
Organization Name:MULTICARE HEALTH & EDUCATIONAL SERVICES INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD/RN
Authorized Official - Phone:216-731-8900
Mailing Address - Street 1:27691 EUCLID AVE
Mailing Address - Street 2:B1
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3550
Mailing Address - Country:US
Mailing Address - Phone:216-731-8900
Mailing Address - Fax:216-731-8972
Practice Address - Street 1:27691 EUCLID AVE
Practice Address - Street 2:B1
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3550
Practice Address - Country:US
Practice Address - Phone:216-731-8900
Practice Address - Fax:216-731-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH524209285251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2015563Medicaid
OH367731Medicare ID - Type UnspecifiedHOME HEALTH SERVICES