Provider Demographics
NPI:1720516644
Name:EKECHUKWU, KENNETH KELECHI JR (ENGR)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:KELECHI
Last Name:EKECHUKWU
Suffix:JR
Gender:M
Credentials:ENGR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 GRANTLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2508
Mailing Address - Country:US
Mailing Address - Phone:216-394-3329
Mailing Address - Fax:
Practice Address - Street 1:1408 GRANTLEIGH RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2508
Practice Address - Country:US
Practice Address - Phone:216-394-3329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376J00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1831246Medicaid