Provider Demographics
NPI:1700201118
Name:TAMARA M COWANS
Entity Type:Organization
Organization Name:TAMARA M COWANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COWANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-205-1093
Mailing Address - Street 1:9409 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-5417
Mailing Address - Country:US
Mailing Address - Phone:216-205-1093
Mailing Address - Fax:
Practice Address - Street 1:9409 EASTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-5417
Practice Address - Country:US
Practice Address - Phone:216-205-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400171191002311ZA0620X, 315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities