Most Relevant Information
Provider Data
| NPI Number: | 1003486010 |
| Provider Name: | JONATHAN EASTRIDGE |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/30/2021 |
| Last Updated: | 06/30/2021 |
Provider Practice Location
115 PRIVATE ROAD 977
PEDRO
OH
456598608
Practice Location Phone/Fax
| Phone: | 7405341386 |
| Fax: | 7405341497 |
Provider Mailing Location
115 PRIVATE ROAD 977
PEDRO
OH
456598608
Provider Mailing Phone/Fax
| Phone: | 7405341386 |
| Fax: | 7405341497 |