Provider Demographics
NPI:1609845593
Name:W.R. CATERING, INC.
Entity Type:Organization
Organization Name:W.R. CATERING, INC.
Other - Org Name:WESTERN RESERVE CATERING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:RT BA
Authorized Official - Phone:440-729-6800
Mailing Address - Street 1:11642 AQUILLA RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-7927
Mailing Address - Country:US
Mailing Address - Phone:440-635-0202
Mailing Address - Fax:866-319-5481
Practice Address - Street 1:12550 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHESTERLAND
Practice Address - State:OH
Practice Address - Zip Code:44026-2560
Practice Address - Country:US
Practice Address - Phone:440-729-6800
Practice Address - Fax:866-319-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2210799251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2210799Medicaid