Provider Demographics
NPI:1952774556
Name:VALENTINE, CHARAEL LEIASHA (LPN/LVN)
Entity Type:Individual
Prefix:MS
First Name:CHARAEL
Middle Name:LEIASHA
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:LPN/LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 VALLEJO DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6130
Mailing Address - Country:US
Mailing Address - Phone:419-356-6128
Mailing Address - Fax:567-315-8598
Practice Address - Street 1:4654 VALLEJO DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6130
Practice Address - Country:US
Practice Address - Phone:419-356-6128
Practice Address - Fax:567-315-8598
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-04
Last Update Date:2023-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401715600115374U00000X, 311ZA0620X
OH185418164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home