Provider Demographics
NPI:1023707635
Name:BRANHAM, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BRANHAM
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 1:15909 HARRISON DR
Mailing Address - Street 2:
Mailing Address - City:BROOKPARK
Mailing Address - State:OH
Mailing Address - Zip Code:44142-1936
Mailing Address - Country:US
Mailing Address - Phone:216-409-7538
Mailing Address - Fax:
Practice Address - Street 1:15909 HARRISON DR
Practice Address - Street 2:
Practice Address - City:BROOKPARK
Practice Address - State:OH
Practice Address - Zip Code:44142-1936
Practice Address - Country:US
Practice Address - Phone:216-409-7538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty