Provider Demographics
NPI:1689896193
Name:CAREERSOURCE MANAGEMENT
Entity Type:Organization
Organization Name:CAREERSOURCE MANAGEMENT
Other - Org Name:MEDSOURCE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-289-9112
Mailing Address - Street 1:27801 EUCLID AVENUE
Mailing Address - Street 2:100
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132
Mailing Address - Country:US
Mailing Address - Phone:216-289-9112
Mailing Address - Fax:216-289-9114
Practice Address - Street 1:27801 EUCLID AVENUE
Practice Address - Street 2:100
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132
Practice Address - Country:US
Practice Address - Phone:216-289-9112
Practice Address - Fax:216-289-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2461769Medicaid
OH2736249Medicaid
OH2893525Medicaid
OH2893525Medicaid