Provider Demographics
NPI:1598242125
Name:PRODUCTIVE HEALTH CARE
Entity Type:Organization
Organization Name:PRODUCTIVE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERMAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-331-3736
Mailing Address - Street 1:3050 LAKESIDE AVE E
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-3716
Mailing Address - Country:US
Mailing Address - Phone:216-331-3736
Mailing Address - Fax:216-331-3735
Practice Address - Street 1:3050 LAKESIDE AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-3716
Practice Address - Country:US
Practice Address - Phone:216-331-3736
Practice Address - Fax:216-331-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health