Organization
CARESTAR (ODJFS)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LACINDA JENKINS (LPN)
(216) 217-0463
Entity
Organization
Contact information
Practice address
3263 E 123RD ST, CLEVELAND, OH 44120-3849
(216) 217-0463
Mailing address
3263 E 123RD ST, CLEVELAND, OH 44120-3849
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN142508
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2851329
—
OH
Enumeration date
12/17/2010
Last updated
12/17/2010
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