MEDICARE: MARY CLINKSCALES

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	251E00000X	Home Health Agency		OH

General Provider Information

NPI Number	:	1497497770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CLINKSCALES

Provider Business Mailing Address
First Line	:	17802 LAKE SHORE BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-1232
Country	:	US
Telephone Number	:	216-848-8576
Fax Number	:

Provider Business Practice Location Address
First Line	:	17802 LAKE SHORE BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-1232
Country	:	US
Telephone Number	:	216-848-8576
Fax Number	:

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

Provider Enumeration Date	:	04/08/2022
Last Update Date	:	04/08/2022

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Directions to “ MARY CLINKSCALES ” Practice Location

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