Provider Demographics
NPI:1114650363
Name:GRIFFIN, BAHOTE
Entity Type:Individual
Prefix:
First Name:BAHOTE
Middle Name:
Last Name:GRIFFIN
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 1:1422 SOM CENTER RD APT 619
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2120
Mailing Address - Country:US
Mailing Address - Phone:330-701-4568
Mailing Address - Fax:
Practice Address - Street 1:1422 SOM CENTER RD APT 619
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44124-2120
Practice Address - Country:US
Practice Address - Phone:330-701-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator