Provider Demographics
NPI:1942688312
Name:CD HEALTHCARE ASSOCIATE LLC
Entity Type:Organization
Organization Name:CD HEALTHCARE ASSOCIATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDADO
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:216-313-0154
Mailing Address - Street 1:1243 PORTAGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-5704
Mailing Address - Country:US
Mailing Address - Phone:216-313-0154
Mailing Address - Fax:
Practice Address - Street 1:1243 PORTAGE LINE RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-5704
Practice Address - Country:US
Practice Address - Phone:216-313-0154
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-18
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.06660-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty