Provider Demographics
NPI:1982042016
Name:RU-CLARE ADULT DAYCARE CENTER
Entity Type:Organization
Organization Name:RU-CLARE ADULT DAYCARE CENTER
Other - Org Name:WRAAA (PASSPORT)
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:JEANETTE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:216-378-0400
Mailing Address - Street 1:23175 COMMERCE PARK
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5806
Mailing Address - Country:US
Mailing Address - Phone:216-378-0400
Mailing Address - Fax:216-591-1850
Practice Address - Street 1:23175 COMMERCE PARK
Practice Address - Street 2:BLDG 2
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5806
Practice Address - Country:US
Practice Address - Phone:216-378-0400
Practice Address - Fax:216-591-1850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1024448Medicaid