Provider Demographics
NPI: | 1164190344 |
---|---|
Name: | CRONE, RANDALL S SR |
Entity Type: | Individual |
Prefix: | MR |
First Name: | RANDALL |
Middle Name: | S |
Last Name: | CRONE |
Suffix: | SR |
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: | 1580 PROSPECT ST APT B5 |
Mailing Address - Street 2: | |
Mailing Address - City: | ELYRIA |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 44035-7171 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 440-822-8209 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1580 PROSPECT ST APT B5 |
Practice Address - Street 2: | |
Practice Address - City: | ELYRIA |
Practice Address - State: | OH |
Practice Address - Zip Code: | 44035-7171 |
Practice Address - Country: | US |
Practice Address - Phone: | 440-309-4478 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2021-09-01 |
Last Update Date: | 2021-09-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | HPW8385 | 172A00000X, 253Z00000X, 3747P1801X, 376J00000X, 347C00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 347C00000X | Transportation Services | Private Vehicle | |
No | 172A00000X | Other Service Providers | Driver | |
No | 253Z00000X | Agencies | In Home Supportive Care | |
No | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant |
No | 376J00000X | Nursing Service Related Providers | Homemaker |