Provider Demographics
NPI:1336763036
Name:COMMUNITY EMPLOYMENT FOR ALL
Entity Type:Organization
Organization Name:COMMUNITY EMPLOYMENT FOR ALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORETTA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PRENDERGAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-406-4743
Mailing Address - Street 1:23811 CHAGRIN BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5555
Mailing Address - Country:US
Mailing Address - Phone:330-607-9172
Mailing Address - Fax:
Practice Address - Street 1:23811 CHAGRIN BLVD STE 110
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5555
Practice Address - Country:US
Practice Address - Phone:330-607-9172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02457575Medicaid