Provider Demographics
NPI:1316540396
Name:MCGREW, CASSIDY
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:MCGREW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 DAUGHERTY RD
Mailing Address - Street 2:
Mailing Address - City:STOCKPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43787-9312
Mailing Address - Country:US
Mailing Address - Phone:740-541-1777
Mailing Address - Fax:
Practice Address - Street 1:770 DAUGHERTY RD
Practice Address - Street 2:
Practice Address - City:STOCKPORT
Practice Address - State:OH
Practice Address - Zip Code:43787-9312
Practice Address - Country:US
Practice Address - Phone:740-541-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5801323Medicaid