Provider Demographics
NPI:1528565306
Name:BAILEY, ALFONZO D
Entity Type:Individual
Prefix:
First Name:ALFONZO
Middle Name:D
Last Name:BAILEY
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 1:2201 W 93RD ST APT 4
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-3779
Mailing Address - Country:US
Mailing Address - Phone:216-682-6717
Mailing Address - Fax:
Practice Address - Street 1:3100 E 45TH ST STE 314
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1095
Practice Address - Country:US
Practice Address - Phone:216-682-6717
Practice Address - Fax:888-460-4717
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator