Provider Demographics
NPI:1467999680
Name:SHALON BARNETT
Entity Type:Organization
Organization Name:SHALON BARNETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE TESTED NURSE AIDE
Authorized Official - Prefix:
Authorized Official - First Name:SHALON
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-319-8436
Mailing Address - Street 1:11424 FAIRPORT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3108
Mailing Address - Country:US
Mailing Address - Phone:440-319-8436
Mailing Address - Fax:
Practice Address - Street 1:11424 FAIRPORT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3108
Practice Address - Country:US
Practice Address - Phone:440-319-8436
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSR647363251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0187132Medicaid