Provider Demographics
NPI:1700277118
Name:THOMAS, MONIQUE
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:THOMAS
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 1:4671 COUNTRY LN
Mailing Address - Street 2:APT 206
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5858
Mailing Address - Country:US
Mailing Address - Phone:216-392-7370
Mailing Address - Fax:
Practice Address - Street 1:4671 COUNTRY LN
Practice Address - Street 2:APT 206
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-5858
Practice Address - Country:US
Practice Address - Phone:216-392-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-08
Last Update Date:2015-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle