Basic Information
Provider Information | |||||||||
NPI: | 1942448683 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALATI | ||||||||
FirstName: | MEGAN | ||||||||
MiddleName: | D | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 625 CLEVELAND AVE NW | ||||||||
Address2: |   | ||||||||
City: | CANTON | ||||||||
State: | OH | ||||||||
PostalCode: | 447021805 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3304550374 | ||||||||
FaxNumber: | 3304536716 | ||||||||
Practice Location | |||||||||
Address1: | 1660 NAVE RD SE | ||||||||
Address2: |   | ||||||||
City: | MASSILLON | ||||||||
State: | OH | ||||||||
PostalCode: | 446469604 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3308379411 | ||||||||
FaxNumber: | 3308374603 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/03/2009 | ||||||||
LastUpdateDate: | 08/27/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN434338 | OH | Y |   | Nursing Service Providers | Registered Nurse |   |
ID Information
ID | Type | State | Issuer | Description | 0186915 | 05 | OH |   | MEDICAID | 2850277 | 05 | OH |   | MEDICAID | 7604677 | 01 | OH | ODMRDD CONTRACT NUMBER | OTHER |