Provider Demographics
NPI:1508523390
Name:HENDERSON, DELMAR
Entity Type:Individual
Prefix:
First Name:DELMAR
Middle Name:
Last Name:HENDERSON
Suffix:
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 1:27030 CEDAR RD APT 715
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-1123
Mailing Address - Country:US
Mailing Address - Phone:216-640-1876
Mailing Address - Fax:
Practice Address - Street 1:26055 EMERY RD STE G
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-6211
Practice Address - Country:US
Practice Address - Phone:216-342-4445
Practice Address - Fax:216-342-4443
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator