Provider Demographics
NPI:1245071950
Name:PAYNE, CIERRA
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:
Last Name:PAYNE
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 1:1815 CHRISTIAN AVE APT 408
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-2968
Mailing Address - Country:US
Mailing Address - Phone:419-787-4280
Mailing Address - Fax:
Practice Address - Street 1:1815 CHRISTIAN AVE APT 408
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-2968
Practice Address - Country:US
Practice Address - Phone:419-787-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities