Provider Demographics
NPI:1639626203
Name:TAWANA DUNCAN
Entity Type:Organization
Organization Name:TAWANA DUNCAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAWANA
Authorized Official - Middle Name:LACIENCE
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-242-7777
Mailing Address - Street 1:1363 E 93RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1005
Mailing Address - Country:US
Mailing Address - Phone:216-242-7777
Mailing Address - Fax:
Practice Address - Street 1:1363 EAST 93RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-242-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities