Provider Demographics
NPI:1689260960
Name:CASSIDY CARE LLC
Entity Type:Organization
Organization Name:CASSIDY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-685-0249
Mailing Address - Street 1:2122 UTAH CT NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3732
Mailing Address - Country:US
Mailing Address - Phone:330-685-0249
Mailing Address - Fax:
Practice Address - Street 1:2122 UTAH CT NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3732
Practice Address - Country:US
Practice Address - Phone:330-685-0249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0276852Medicaid