MEDICARE: MS. TONIE SLOCUM

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	261QA0600X	Adult Day Care Clinic/Center		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000000	OTHER	OH	N/A AT THIS TIME

General Provider Information

NPI Number	:	1710163738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TONIE SLOCUM

Provider Business Mailing Address
First Line	:	1873 PROSPECT AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2313
Country	:	US
Telephone Number	:	216-589-9447
Fax Number	:	216-589-9446

Provider Business Practice Location Address
First Line	:	1873 PROSPECT AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2313
Country	:	US
Telephone Number	:	216-589-9447
Fax Number	:	216-589-9446

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

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	01/23/2008

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