Provider Demographics
NPI:1376146175
Name:CALCOTE, RITA (IP)
Entity Type:Individual
Prefix:MS
First Name:RITA
Middle Name:
Last Name:CALCOTE
Suffix:
Gender:M
Credentials:IP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 603134
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44103-0134
Mailing Address - Country:US
Mailing Address - Phone:216-235-2067
Mailing Address - Fax:
Practice Address - Street 1:1501 E 191ST ST APT 207
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1347
Practice Address - Country:US
Practice Address - Phone:216-235-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH189891626501Medicaid