Provider Demographics
NPI:1548390917
Name:INDEPENDENTPROVIDER
Entity Type:Organization
Organization Name:INDEPENDENTPROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOMEHEALTHAIDE
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMEA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-322-8018
Mailing Address - Street 1:2499 E 84TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-2207
Mailing Address - Country:US
Mailing Address - Phone:216-322-8018
Mailing Address - Fax:
Practice Address - Street 1:11501 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-5942
Practice Address - Country:US
Practice Address - Phone:216-231-9682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization