Provider Demographics
NPI:1558782722
Name:LAKISHA CALHOUN
Entity Type:Organization
Organization Name:LAKISHA CALHOUN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING ASSISTANT
Authorized Official - Phone:216-258-5663
Mailing Address - Street 1:18661 RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1632
Mailing Address - Country:US
Mailing Address - Phone:216-663-3441
Mailing Address - Fax:
Practice Address - Street 1:18661 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1643
Practice Address - Country:US
Practice Address - Phone:216-258-5663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
311ZA0620X
OH379692680301311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home