Provider Demographics
NPI:1659607455
Name:JM CLEMENTE CO. LTD
Entity Type:Organization
Organization Name:JM CLEMENTE CO. LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CLEMENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-392-7069
Mailing Address - Street 1:3100 NILES RD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-3276
Mailing Address - Country:US
Mailing Address - Phone:330-392-7069
Mailing Address - Fax:330-392-7071
Practice Address - Street 1:3100 NILES RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-3276
Practice Address - Country:US
Practice Address - Phone:330-392-7069
Practice Address - Fax:330-392-7071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2939388Medicaid
OH7801552OtherODMRDD