Provider Demographics
NPI:1013554245
Name:ELDERCARE SERVICES INSTITUTE, LLC
Entity Type:Organization
Organization Name:ELDERCARE SERVICES INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARITA
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA,MHSA
Authorized Official - Phone:216-373-1807
Mailing Address - Street 1:11890 FAIRHILL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1053
Mailing Address - Country:US
Mailing Address - Phone:216-791-8000
Mailing Address - Fax:216-373-1816
Practice Address - Street 1:11890 FAIRHILL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1053
Practice Address - Country:US
Practice Address - Phone:216-791-8000
Practice Address - Fax:216-373-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871950Medicaid