Provider Demographics
NPI:1043011505
Name:ISCREAM SOCIAL LLC
Entity type:Organization
Organization Name:ISCREAM SOCIAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DORNICE
Authorized Official - Middle Name:IVANNA
Authorized Official - Last Name:FRIDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-348-4524
Mailing Address - Street 1:928 GLENSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3442
Mailing Address - Country:US
Mailing Address - Phone:330-348-4524
Mailing Address - Fax:
Practice Address - Street 1:928 GLENSIDE RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3442
Practice Address - Country:US
Practice Address - Phone:330-348-4524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health