Provider Demographics
NPI:1114702313
Name:MENJIVAR, JOSELINE
Entity Type:Individual
Prefix:
First Name:JOSELINE
Middle Name:
Last Name:MENJIVAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 STATE RD STE 8C
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2263
Mailing Address - Country:US
Mailing Address - Phone:216-356-9063
Mailing Address - Fax:
Practice Address - Street 1:5530 STATE RD STE 8C
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2263
Practice Address - Country:US
Practice Address - Phone:216-356-9063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X, 174200000X, 253Z00000X, 332U00000X
OH1831533385H00000X, 251E00000X, 172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
No174200000XOther Service ProvidersMeals
No172A00000XOther Service ProvidersDriver
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1831533Medicaid