Provider Demographics
NPI:1518593995
Name:RICHARDSON, STEPHANIE R
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2919 EAST 130TH STREET
Mailing Address - Street 2:DOWN
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2641
Mailing Address - Country:US
Mailing Address - Phone:216-727-6799
Mailing Address - Fax:
Practice Address - Street 1:2919 EAST 130TH STREET
Practice Address - Street 2:DOWN
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2641
Practice Address - Country:US
Practice Address - Phone:216-727-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide