Provider Demographics
NPI:1326479643
Name:ANTONIO BOYD
Entity Type:Organization
Organization Name:ANTONIO BOYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-239-9968
Mailing Address - Street 1:6200 LEE RD S
Mailing Address - Street 2:APT 207
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-4539
Mailing Address - Country:US
Mailing Address - Phone:216-239-9968
Mailing Address - Fax:
Practice Address - Street 1:6200 LEE RD S
Practice Address - Street 2:APT 207
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-4539
Practice Address - Country:US
Practice Address - Phone:216-239-9968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400412651004311500000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)