MEDICARE: LEILA HIGGINBOTHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	385H00000X	Respite Care	601413470521	OH
2	251E00000X	Home Health Agency	601413470521	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093472623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILA HIGGINBOTHAM

Provider Business Mailing Address
First Line	:	1936 E 41ST ST
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-2612
Country	:	US
Telephone Number	:	440-225-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 E 41ST ST
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-2612
Country	:	US
Telephone Number	:	440-225-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2021
Last Update Date	:	12/22/2024

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Directions to “ LEILA HIGGINBOTHAM ” Practice Location

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