Provider Demographics
NPI:1780100644
Name:MITCHELL, ELISHA
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:
Last Name:MITCHELL
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 1:112 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-2404
Mailing Address - Country:US
Mailing Address - Phone:419-908-2229
Mailing Address - Fax:
Practice Address - Street 1:112 BLOOMFIELD AVE.
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607
Practice Address - Country:US
Practice Address - Phone:419-908-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services