MEDICARE: JEANNETTE JENKINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	132700000X	Dietary Manager
2	171R00000X	Interpreter
3	372500000X	Chore Provider
4	372600000X	Adult Companion	OH
5	3747A0650X	Attendant Care Provider
6	3747P1801X	Personal Care Attendant
7	376J00000X	Homemaker
8	373H00000X	Day Training/Habilitation Specialist	OH

General Provider Information

NPI Number	:	1568223592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNETTE JENKINS

Provider Business Mailing Address
First Line	:	4149 EASTWOOD LN
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44122-7039
Country	:	US
Telephone Number	:	216-372-5214
Fax Number	:

Provider Business Practice Location Address
First Line	:	4172 E 187TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44122-6954
Country	:	US
Telephone Number	:	216-372-5214
Fax Number	:

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

Provider Enumeration Date	:	01/17/2024
Last Update Date	:	01/17/2024

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Directions to “ JEANNETTE JENKINS ” Practice Location

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