Provider Demographics
NPI:1073972295
Name:JESSICA RIOS
Entity Type:Organization
Organization Name:JESSICA RIOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-767-1216
Mailing Address - Street 1:3059 W 44TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-4817
Mailing Address - Country:US
Mailing Address - Phone:618-767-1216
Mailing Address - Fax:
Practice Address - Street 1:3059 W 44TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-4817
Practice Address - Country:US
Practice Address - Phone:618-767-1216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0149266Medicaid