Active NPI
Clifford Chiles Craddock II
- Nursing Home Administrator
- Eaton, OH
National Provider Identifier
1497566400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Home Administrator
- License
- 4118
- Practice address
- 411 E Wadsworth St
Eaton, OH 45320-2357 - Phone
- (513) 804-8148
- NPI assigned
- Jan 17, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Home Administrator | 376G00000X | 4118 | OH | Primary |
Addresses
Primary practice location
411 E Wadsworth St
Eaton, OH 45320-2357
Mailing address
411 E Wadsworth St
Eaton, OH 45320-2357
Phone (513) 804-8148
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4118 | OH | MD | Nursing Home Administrator |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737072000000",
"number": "1497566400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 E WADSWORTH ST",
"city": "EATON",
"state": "OH",
"postal_code": "453202357",
"telephone_number": "513-804-8148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 E WADSWORTH ST",
"city": "EATON",
"state": "OH",
"postal_code": "453202357",
"telephone_number": "513-804-8148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRADDOCK",
"first_name": "CLIFFORD",
"middle_name": "CHILES",
"name_suffix": "II",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-01-17",
"last_updated": "2025-01-17",
"certification_date": "2025-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "376G00000X",
"taxonomy_group": "",
"desc": "Nursing Home Administrator",
"state": "OH",
"license": "4118",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eaton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.