Matthew J Tekaucic

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

5213901 Issued in OH

Practice address

286 Baird Ave
Wadsworth, OH 44281-2220

Phone

(330) 441-2311

NPI assigned

Nov 25, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606262400000",
    "number": "1356945893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "559 CRESTWOOD AVE",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442811928",
            "telephone_number": "330-441-2311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 BAIRD AVE",
            "city": "WADSWORTH",
            "state": "OH",
            "postal_code": "442812220",
            "telephone_number": "330-441-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEKAUCIC",
        "first_name": "MATTHEW",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-25",
        "last_updated": "2020-11-25",
        "certification_date": "2020-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "5213901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5213901",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan J Hudson, CNM, LLC
• Dora Sword
• Julie Susan Tague, PHARMD
• Taylor Sweigert
• Susan Caroline Taylor, RN
• Dusty Terrill
• Lois J Teston, MD
• The Allergy and Asthma Treatment Center
• The Cleveland Clinic Foundation
• The Inn at Coalridge Management Co. LLC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Wadsworth, OH
• Providers in Wadsworth, OH by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.