MEDICARE: MRS. VILLIE A HAYES

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	171M00000X	Case Manager/Care Coordinator		OH

General Provider Information

NPI Number	:	1477169878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VILLIE A HAYES

Provider Business Mailing Address
First Line	:	1065 MEDINA RD
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-5375
Country	:	US
Telephone Number	:	330-596-1042
Fax Number	:	330-532-0038

Provider Business Practice Location Address
First Line	:	7292 MEADOWHAVEN DR
Second Line	:
City	:	CHIPPEWA LAKE
State	:	OH
Zip	:	44215-9805
Country	:	US
Telephone Number	:	216-346-0829
Fax Number	:

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

Provider Enumeration Date	:	09/21/2020
Last Update Date	:	09/21/2020

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