Provider Demographics
NPI:1750996732
Name:RICHELSON, JOAN
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:RICHELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:RICHELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2231 S GREEN RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3325
Mailing Address - Country:US
Mailing Address - Phone:440-944-6062
Mailing Address - Fax:
Practice Address - Street 1:2231 S GREEN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44121-3325
Practice Address - Country:US
Practice Address - Phone:440-944-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health