Individual
MS. CHERYL BASTULLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1135 E 346TH ST, EASTLAKE, OH 44095-2947
(440) 669-0640
Mailing address
1135 E 346TH ST, EASTLAKE, OH 44095-2947
(440) 669-0640
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
274348
OH
261QA0600X
Adult Day Care Clinic/Center
274348
OH
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
274348
OH
343900000X
Non-emergency Medical Transport (VAN)
274348
OH
347C00000X
Private Vehicle
274348
OH
Other
Enumeration date
12/08/2020
Last updated
12/08/2020
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