Provider Demographics
NPI:1215192687
Name:CENTER OF EXCELLENCE FOR GERIATRIC CARE
Entity Type:Organization
Organization Name:CENTER OF EXCELLENCE FOR GERIATRIC CARE
Other - Org Name:BOOMERCARE TECHNOLOGIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER OF ARTS
Authorized Official - Phone:330-414-8352
Mailing Address - Street 1:2143 CROSS CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1257
Mailing Address - Country:US
Mailing Address - Phone:330-414-8352
Mailing Address - Fax:330-922-4316
Practice Address - Street 1:2143 CROSS CREEK TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1257
Practice Address - Country:US
Practice Address - Phone:330-414-8352
Practice Address - Fax:330-922-4316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1779730332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies