Provider Demographics
NPI:1073948949
Name:CARR, STACEY ROBYN (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:ROBYN
Last Name:CARR
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 ALGONQUIN RD
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-2401
Mailing Address - Country:US
Mailing Address - Phone:216-820-1804
Mailing Address - Fax:
Practice Address - Street 1:2105 ALGONQUIN ROAD
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117
Practice Address - Country:US
Practice Address - Phone:216-820-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide