Provider Demographics
NPI:1205383544
Name:TYLINE M. HOOD
Entity Type:Organization
Organization Name:TYLINE M. HOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERSONAL CARE AIDE
Authorized Official - Prefix:
Authorized Official - First Name:TYLINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-409-7608
Mailing Address - Street 1:15000 TABOR AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3867
Mailing Address - Country:US
Mailing Address - Phone:216-409-7608
Mailing Address - Fax:
Practice Address - Street 1:15000 TABOR AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-3867
Practice Address - Country:US
Practice Address - Phone:216-409-7608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-03
Last Update Date:2016-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0173125251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0173125Medicaid