Provider Demographics
NPI:1427528553
Name:AKOMA HEALTH LLC
Entity type:Organization
Organization Name:AKOMA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNCHES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:216-326-7487
Mailing Address - Street 1:2219 E 73RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-4827
Mailing Address - Country:US
Mailing Address - Phone:216-326-7487
Mailing Address - Fax:
Practice Address - Street 1:2219 E 73RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-4827
Practice Address - Country:US
Practice Address - Phone:216-326-7487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-02
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy