Provider Demographics
NPI:1982025433
Name:CHARLOTTE PHILLIPS
Entity Type:Organization
Organization Name:CHARLOTTE PHILLIPS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-450-0598
Mailing Address - Street 1:631 LEE RD
Mailing Address - Street 2:APT 1210
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3496
Mailing Address - Country:US
Mailing Address - Phone:216-450-0598
Mailing Address - Fax:
Practice Address - Street 1:631 LEE RD
Practice Address - Street 2:APT 1210
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3496
Practice Address - Country:US
Practice Address - Phone:216-450-0598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN352736311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home