Provider Demographics
NPI:1245290618
Name:EASTER SEALS NORTHERN OHIO
Entity type:Organization
Organization Name:EASTER SEALS NORTHERN OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-838-0990
Mailing Address - Street 1:1929A E ROYALTON RD
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2809
Mailing Address - Country:US
Mailing Address - Phone:440-838-0990
Mailing Address - Fax:440-838-8440
Practice Address - Street 1:1929A E ROYALTON RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2809
Practice Address - Country:US
Practice Address - Phone:440-838-0990
Practice Address - Fax:440-838-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849916Medicaid
OH7700349OtherMEDICAID WAIVER HOMECARE