Provider Demographics
NPI:1477030641
Name:CLEVELAND, KRASHANDA (BA, MBA)
Entity Type:Individual
Prefix:
First Name:KRASHANDA
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:BA, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 W CENTER ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-1371
Mailing Address - Country:US
Mailing Address - Phone:414-366-4514
Mailing Address - Fax:414-877-5843
Practice Address - Street 1:6505 W CENTER ST APT 2
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-1371
Practice Address - Country:US
Practice Address - Phone:414-366-4514
Practice Address - Fax:414-877-5843
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251K00000XAgenciesPublic Health or Welfare
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide