Provider Demographics
NPI:1356775159
Name:PAIGE FITCH
Entity type:Organization
Organization Name:PAIGE FITCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:216-812-5256
Mailing Address - Street 1:2627 COLCHESTER RD
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3664
Mailing Address - Country:US
Mailing Address - Phone:216-812-5256
Mailing Address - Fax:
Practice Address - Street 1:2627 COLCHESTER RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3664
Practice Address - Country:US
Practice Address - Phone:216-812-5256
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN126022-M-IV320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities