MEDICARE: BRESHAY RAIMON JOHNSON

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	172A00000X	Driver
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1164203998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRESHAY RAIMON JOHNSON

Provider Business Mailing Address
First Line	:	6047 HILLMAN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1755
Country	:	US
Telephone Number	:	216-672-8055
Fax Number	:

Provider Business Practice Location Address
First Line	:	6047 HILLMAN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1755
Country	:	US
Telephone Number	:	216-672-8055
Fax Number	:

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

Provider Enumeration Date	:	10/09/2023
Last Update Date	:	10/09/2023

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Directions to “ BRESHAY RAIMON JOHNSON ” Practice Location

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