Provider Demographics
NPI:1679810386
Name:EDU-AT-TECH, LLC
Entity Type:Organization
Organization Name:EDU-AT-TECH, LLC
Other - Org Name:EDUCATIONAL ASSISTIVE TECHNOLOGY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIES
Authorized Official - Middle Name:NICHELLE
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-217-0561
Mailing Address - Street 1:PO BOX 91666
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-3666
Mailing Address - Country:US
Mailing Address - Phone:216-217-0561
Mailing Address - Fax:
Practice Address - Street 1:7102 WAKEFIELD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2972
Practice Address - Country:US
Practice Address - Phone:216-217-0561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDU-AT-TECH, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20799332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0059044Medicaid