Provider Demographics
NPI:1891540407
Name:THOMAS, DANNY R
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:R
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12611 LARCHMERE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1109
Mailing Address - Country:US
Mailing Address - Phone:216-244-4643
Mailing Address - Fax:
Practice Address - Street 1:25595 CHARDON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1207
Practice Address - Country:US
Practice Address - Phone:216-244-4643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care