MEDICARE: DANNIEL ALEXANDRIA MCCLAIN

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1619756475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANNIEL ALEXANDRIA MCCLAIN

Provider Business Mailing Address
First Line	:	3912 E ANTISDALE RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44118-2332
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3912 E ANTISDALE RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44118-2332
Country	:	US
Telephone Number	:	216-294-7375
Fax Number	:

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

Provider Enumeration Date	:	09/21/2023
Last Update Date	:	09/21/2023

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