Provider Demographics
NPI:1477678738
Name:A BRAND NEW START ADULT DAY CARE
Entity Type:Organization
Organization Name:A BRAND NEW START ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOROWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:216-382-2222
Mailing Address - Street 1:533 S GREEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2818
Mailing Address - Country:US
Mailing Address - Phone:440-840-2491
Mailing Address - Fax:440-878-5026
Practice Address - Street 1:533 S GREEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2818
Practice Address - Country:US
Practice Address - Phone:440-840-2491
Practice Address - Fax:440-878-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1586523261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2613523Medicaid
OH2650126Medicaid
OH2707771Medicaid