Provider Demographics
NPI:1851995708
Name:RIVERA, ELIZABETH (HOME AID)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:HOME AID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 W 31ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1507
Mailing Address - Country:US
Mailing Address - Phone:216-322-6620
Mailing Address - Fax:
Practice Address - Street 1:3153 W 31ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1507
Practice Address - Country:US
Practice Address - Phone:216-322-6620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1898920Medicaid