MEDICARE: DELENA CRYSTAL BOLDEN

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	376J00000X	Homemaker		OH

General Provider Information

NPI Number	:	1164360061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELENA CRYSTAL BOLDEN

Provider Business Mailing Address
First Line	:	3355 W 95TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4703
Country	:	US
Telephone Number	:	216-560-1480
Fax Number	:

Provider Business Practice Location Address
First Line	:	3355 W 95TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4703
Country	:	US
Telephone Number	:	216-560-1480
Fax Number	:

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

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “ DELENA CRYSTAL BOLDEN ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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