Provider Demographics
NPI:1952560666
Name:PALMORE, BERTHA A
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:A
Last Name:PALMORE
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 1:2599 ROMIG RD
Mailing Address - Street 2:APT 18
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3865
Mailing Address - Country:US
Mailing Address - Phone:330-745-4566
Mailing Address - Fax:
Practice Address - Street 1:2599 ROMIG RD
Practice Address - Street 2:APT 18
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3865
Practice Address - Country:US
Practice Address - Phone:330-745-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2738470Medicaid