Provider Demographics
NPI:1033455894
Name:ALL CONQUERED CARE
Entity Type:Organization
Organization Name:ALL CONQUERED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRDINA
Authorized Official - Middle Name:LAFAYE
Authorized Official - Last Name:GOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:216-258-2597
Mailing Address - Street 1:1412 VILLA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2904
Mailing Address - Country:US
Mailing Address - Phone:216-258-2597
Mailing Address - Fax:
Practice Address - Street 1:1412 VILLA DR
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2904
Practice Address - Country:US
Practice Address - Phone:216-258-2597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH348737302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization