Provider Demographics
NPI:1457039281
Name:FOURTH DOWN LLC
Entity Type:Organization
Organization Name:FOURTH DOWN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:GRABER
Authorized Official - Suffix:
Authorized Official - Credentials:CD,CPD,CLC
Authorized Official - Phone:216-313-0362
Mailing Address - Street 1:332 TIMBERIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:GATES MILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44040-9319
Mailing Address - Country:US
Mailing Address - Phone:216-313-0362
Mailing Address - Fax:
Practice Address - Street 1:332 TIMBERIDGE TRL
Practice Address - Street 2:
Practice Address - City:GATES MILLS
Practice Address - State:OH
Practice Address - Zip Code:44040-9319
Practice Address - Country:US
Practice Address - Phone:216-313-0362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty