MEDICARE: ANGEL BUTLER

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	311ZA0620X	Adult Care Home Facility	376865411097	OH

General Provider Information

NPI Number	:	1699715482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANGEL BUTLER

Provider Business Mailing Address
First Line	:	20251 FULLER AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2636
Country	:	US
Telephone Number	:	216-255-1613
Fax Number	:

Provider Business Practice Location Address
First Line	:	20251 FULLER AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2636
Country	:	US
Telephone Number	:	216-255-1613
Fax Number	:

Authorized Official
Title or Position	:	NURSING ASST
Name	:	MS. ANGEL PATRICE BUTLER
Credential	:	STNA
Telephone Number	:	216-692-1079

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/22/2020

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Directions to “ANGEL BUTLER ” Practice Location

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