Provider Demographics
NPI:1699912550
Name:CGA HOME MODIFICATIONS, LLC
Entity type:Organization
Organization Name:CGA HOME MODIFICATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ARROYO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:419-531-2500
Mailing Address - Street 1:5242 ANGOLA RD
Mailing Address - Street 2:#140
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6352
Mailing Address - Country:US
Mailing Address - Phone:419-531-2500
Mailing Address - Fax:419-531-2500
Practice Address - Street 1:5242 ANGOLA RD
Practice Address - Street 2:#140
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6352
Practice Address - Country:US
Practice Address - Phone:419-531-2500
Practice Address - Fax:419-531-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.007182225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2899672Medicaid
OHCG9379021Medicare UPIN