Individual
ANTHONY PASSALACQUA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2789 MATHERS WAY, TWINSBURG, OH 44087-2625
(216) 548-7997
Mailing address
2789 MATHERS WAY, TWINSBURG, OH 44087-2625
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/07/2020
Last updated
12/07/2020
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