Healthcare Provider Details

I. General information

NPI: 1609346600
Provider Name (Legal Business Name): TAMAJEWELS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 STORER AVE
AKRON OH
44320-2051
US

IV. Provider business mailing address

488 STORER AVE
AKRON OH
44320-2051
US

V. Phone/Fax

Practice location:
  • Phone: 330-289-7567
  • Fax:
Mailing address:
  • Phone: 330-289-7567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LANINA JEAN JOHNSON
Title or Position: CEO
Credential:
Phone: 330-289-7567