Provider Demographics
NPI:1881213353
Name:JAKE, DAVID R
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:JAKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 CLEARBROOK DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-5732
Mailing Address - Country:US
Mailing Address - Phone:440-478-6999
Mailing Address - Fax:
Practice Address - Street 1:3020 CLEARBROOK DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-5732
Practice Address - Country:US
Practice Address - Phone:440-478-6999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No251E00000XAgenciesHome Health