Provider Demographics
NPI:1467274779
Name:FRANCIS, GERSHOM
Entity type:Individual
Prefix:
First Name:GERSHOM
Middle Name:
Last Name:FRANCIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23366 COMMERCE PARK STE 100B
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5801
Mailing Address - Country:US
Mailing Address - Phone:216-292-2880
Mailing Address - Fax:
Practice Address - Street 1:23366 COMMERCE PARK STE 100B
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5801
Practice Address - Country:US
Practice Address - Phone:216-292-2880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0346639Medicaid