Provider Demographics
NPI:1750641635
Name:HANNAH, STACEY M (CEO)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:M
Last Name:HANNAH
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19016 MAPLE HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2220
Mailing Address - Country:US
Mailing Address - Phone:216-659-1493
Mailing Address - Fax:
Practice Address - Street 1:19016 MAPLE HEIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2220
Practice Address - Country:US
Practice Address - Phone:216-659-1493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver