Provider Demographics
NPI:1407191521
Name:SIMPSON, ALBERT D JR
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:D
Last Name:SIMPSON
Suffix:JR
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 1:392 E 160TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-1612
Mailing Address - Country:US
Mailing Address - Phone:216-288-0858
Mailing Address - Fax:216-531-3911
Practice Address - Street 1:392 E 160TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-1612
Practice Address - Country:US
Practice Address - Phone:216-288-0858
Practice Address - Fax:216-531-3911
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401441680912376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide