Provider Demographics
NPI:1265898134
Name:COMPLETE CARE
Entity type:Organization
Organization Name:COMPLETE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEREKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-506-4233
Mailing Address - Street 1:1310 S DANLEY SQ
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-2259
Mailing Address - Country:US
Mailing Address - Phone:440-506-4233
Mailing Address - Fax:
Practice Address - Street 1:1310 S DANLEY SQ
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-2259
Practice Address - Country:US
Practice Address - Phone:440-506-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401114940710261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health