MEDICARE: MRS. BEVERLY MARIE BOYD

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1134737851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BEVERLY MARIE BOYD

Provider Business Mailing Address
First Line	:	2135 55TH ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-3410
Country	:	US
Telephone Number	:	330-316-3730
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 55TH ST NE
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44721-3410
Country	:	US
Telephone Number	:	330-316-3730
Fax Number	:

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

Provider Enumeration Date	:	07/20/2020
Last Update Date	:	07/20/2020

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