Individual
MATTHEW J TEKAUCIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
286 BAIRD AVE, WADSWORTH, OH 44281-2220
(330) 441-2311
Mailing address
559 CRESTWOOD AVE, WADSWORTH, OH 44281-1928
(330) 441-2311
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
5213901
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5213901
—
OH
Enumeration date
11/25/2020
Last updated
11/25/2020
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