Provider Demographics
NPI:1295274447
Name:JOYCE BURNETT
Entity type:Organization
Organization Name:JOYCE BURNETT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HHA
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:HHA CERTIFICATE
Authorized Official - Phone:216-278-5955
Mailing Address - Street 1:17021 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2211
Mailing Address - Country:US
Mailing Address - Phone:216-278-5955
Mailing Address - Fax:
Practice Address - Street 1:17021 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2211
Practice Address - Country:US
Practice Address - Phone:216-278-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOYCE BURNETT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH305R00000X
OH305S00000X305S00000X
OH302F00000X302F00000X
OH302R00000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No302F00000XManaged Care OrganizationsExclusive Provider Organization