Provider Demographics
NPI:1295111466
Name:INDIVIDUAL PROVIDER
Entity type:Organization
Organization Name:INDIVIDUAL PROVIDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE TESTED NURSE AIDE
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-233-8396
Mailing Address - Street 1:27601 MILLS AVE
Mailing Address - Street 2:#B
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-6015
Mailing Address - Country:US
Mailing Address - Phone:216-233-8396
Mailing Address - Fax:
Practice Address - Street 1:27601 MILLS AVE
Practice Address - Street 2:#B
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44132-6015
Practice Address - Country:US
Practice Address - Phone:216-233-8396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH375626480596385H00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care