Provider Demographics
NPI:1205428505
Name:TRICE, CARLENA KRISTINA
Entity type:Individual
Prefix:
First Name:CARLENA
Middle Name:KRISTINA
Last Name:TRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2133 W 101ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-3636
Mailing Address - Country:US
Mailing Address - Phone:216-855-6559
Mailing Address - Fax:
Practice Address - Street 1:2133 W 101ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-3636
Practice Address - Country:US
Practice Address - Phone:216-855-6559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH103545850299Medicaid