Provider Demographics
NPI:1689086712
Name:MICHELLE BROWN
Entity Type:Organization
Organization Name:MICHELLE BROWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE TESTED NURSE AIDE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-256-1200
Mailing Address - Street 1:13410 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5170
Mailing Address - Country:US
Mailing Address - Phone:215-256-1200
Mailing Address - Fax:
Practice Address - Street 1:13410 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5170
Practice Address - Country:US
Practice Address - Phone:215-256-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400645350707305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service