Provider Demographics
NPI:1922528132
Name:CLEVELAND, EUGENIA HARRIS (PCA)
Entity Type:Individual
Prefix:
First Name:EUGENIA
Middle Name:HARRIS
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-2538
Mailing Address - Country:US
Mailing Address - Phone:513-903-2656
Mailing Address - Fax:
Practice Address - Street 1:64 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-2538
Practice Address - Country:US
Practice Address - Phone:513-903-2656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
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
OH0183247Medicaid