Provider Demographics
NPI:1679845697
Name:KELDRIC COMPANION ADULT DAY CENTER
Entity Type:Organization
Organization Name:KELDRIC COMPANION ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:LOREAN
Authorized Official - Last Name:KNUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-521-4525
Mailing Address - Street 1:5615 PERKINS RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2558
Mailing Address - Country:US
Mailing Address - Phone:440-521-4525
Mailing Address - Fax:440-543-6054
Practice Address - Street 1:5615 PERKINS RD
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-2558
Practice Address - Country:US
Practice Address - Phone:440-521-4525
Practice Address - Fax:440-543-6054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0058661Medicaid