Provider Demographics
NPI:1992791933
Name:CAGAJIB, INC.
Entity type:Organization
Organization Name:CAGAJIB, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-353-2900
Mailing Address - Street 1:5485 STATE ROUTE 128
Mailing Address - Street 2:
Mailing Address - City:CLEVES
Mailing Address - State:OH
Mailing Address - Zip Code:45002-9439
Mailing Address - Country:US
Mailing Address - Phone:513-353-2900
Mailing Address - Fax:513-353-2988
Practice Address - Street 1:5485 STATE ROUTE 128
Practice Address - Street 2:
Practice Address - City:CLEVES
Practice Address - State:OH
Practice Address - Zip Code:45002-9439
Practice Address - Country:US
Practice Address - Phone:513-353-2900
Practice Address - Fax:513-353-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6253314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2517235Medicaid
OH2517235Medicaid