Provider Demographics
NPI:1952912339
Name:WILLIAMS, TIARA NATASHA (HOME HEALTH AID)
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:NATASHA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:HOME HEALTH AID
Other - Prefix:
Other - First Name:TIARA
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:HOME HEALTH AID
Mailing Address - Street 1:9103 ROSEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6650
Mailing Address - Country:US
Mailing Address - Phone:216-622-5559
Mailing Address - Fax:
Practice Address - Street 1:9103 ROSEWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44105-6650
Practice Address - Country:US
Practice Address - Phone:216-622-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14032041T374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty