Provider Demographics
NPI:1811595630
Name:COOK, AVA (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:COOK
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:CATREECE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2689 E 110TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3502
Mailing Address - Country:US
Mailing Address - Phone:216-450-0551
Mailing Address - Fax:
Practice Address - Street 1:2689 E 110TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3502
Practice Address - Country:US
Practice Address - Phone:216-450-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7771Medicaid