Provider Demographics
NPI:1699006643
Name:IBARIHEALTH
Entity Type:Organization
Organization Name:IBARIHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-687-8007
Mailing Address - Street 1:17000 SAINT CLAIR AVE
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-2535
Mailing Address - Country:US
Mailing Address - Phone:773-687-8007
Mailing Address - Fax:
Practice Address - Street 1:17000 SAINT CLAIR AVE
Practice Address - Street 2:BUILDING 1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-2535
Practice Address - Country:US
Practice Address - Phone:773-687-8007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health