Provider Demographics
NPI:1205389319
Name:SOAMAZIN AUTOMOTIVE
Entity Type:Organization
Organization Name:SOAMAZIN AUTOMOTIVE
Other - Org Name:SOAMAZIN HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:216-358-3138
Mailing Address - Street 1:14115 MAPLEROW AVE
Mailing Address - Street 2:MAPLEROW
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6447
Mailing Address - Country:US
Mailing Address - Phone:216-358-3138
Mailing Address - Fax:
Practice Address - Street 1:14115 MAPLEROW AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6447
Practice Address - Country:US
Practice Address - Phone:216-358-3138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH141124313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility