Organization
TWELVE SIXTYTHREE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARMAINE ROSS (OWNER)
(216) 577-6562
Entity
Organization
Contact information
Practice address
1003 NEWBERRY AVE, CLEVELAND, OH 44121-3447
(440) 295-4319
Mailing address
1003 NEWBERRY AVE, CLEVELAND, OH 44121-3447
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
251B00000X
Case Management Agency
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
08/18/2025
Last updated
08/21/2025
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