Provider Demographics
NPI:1497466601
Name:EMBRACE INDEPENDENCE LLC
Entity Type:Organization
Organization Name:EMBRACE INDEPENDENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-933-8880
Mailing Address - Street 1:12091 BYERS AVE NE
Mailing Address - Street 2:
Mailing Address - City:HARTVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44632-9724
Mailing Address - Country:US
Mailing Address - Phone:330-933-8880
Mailing Address - Fax:330-232-9796
Practice Address - Street 1:5470 CHEROKEE AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-6844
Practice Address - Country:US
Practice Address - Phone:330-933-8880
Practice Address - Fax:330-232-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility