Provider Demographics
NPI:1225624265
Name:ROBERT J DONNA
Entity Type:Organization
Organization Name:ROBERT J DONNA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:COGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-970-6279
Mailing Address - Street 1:852 HIGHLAND RD E STE 4B
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2150
Mailing Address - Country:US
Mailing Address - Phone:216-970-6279
Mailing Address - Fax:440-791-0808
Practice Address - Street 1:852 HIGHLAND RD E STE 4B
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2150
Practice Address - Country:US
Practice Address - Phone:216-970-6279
Practice Address - Fax:440-791-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7718930Medicaid