Provider Demographics
NPI:1548864689
Name:DELILALAS HOME
Entity type:Organization
Organization Name:DELILALAS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERRIWEATHER
Authorized Official - Suffix:
Authorized Official - Credentials:PEER SUPPORT
Authorized Official - Phone:216-269-7643
Mailing Address - Street 1:10418 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-2760
Mailing Address - Country:US
Mailing Address - Phone:216-253-5377
Mailing Address - Fax:
Practice Address - Street 1:10418 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-2760
Practice Address - Country:US
Practice Address - Phone:216-253-5377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health