Provider Demographics
NPI:1003074659
Name:LAFAWN DAVIS
Entity Type:Organization
Organization Name:LAFAWN DAVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LAFAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-681-0924
Mailing Address - Street 1:1872 TAYLOR RD
Mailing Address - Street 2:1872 TAYLOR RD
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2829
Mailing Address - Country:US
Mailing Address - Phone:216-681-0924
Mailing Address - Fax:
Practice Address - Street 1:1872 TAYLOR RD
Practice Address - Street 2:1872 TAYLOR RD
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2829
Practice Address - Country:US
Practice Address - Phone:216-681-0924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2379886320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities