Provider Demographics
NPI:1073120150
Name:HOLMES, JEREMY M
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:M
Last Name:HOLMES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 QUEEN MARY DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3419
Mailing Address - Country:US
Mailing Address - Phone:216-224-0237
Mailing Address - Fax:
Practice Address - Street 1:12305 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2359
Practice Address - Country:US
Practice Address - Phone:216-541-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator