Provider Demographics
NPI:1821328345
Name:OUR COMMUNITY ADULT CARE
Entity Type:Organization
Organization Name:OUR COMMUNITY ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAUN'DREA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:STNA
Authorized Official - Phone:216-820-8860
Mailing Address - Street 1:9606 MILES AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6122
Mailing Address - Country:US
Mailing Address - Phone:216-820-8860
Mailing Address - Fax:
Practice Address - Street 1:9606 MILES AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6122
Practice Address - Country:US
Practice Address - Phone:216-820-8860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health