Healthcare Provider Details

I. General information

NPI: 1730706938
Provider Name (Legal Business Name): KIA GREENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1478 OVERLOOK DR
AKRON OH
44314-3337
US

IV. Provider business mailing address

1478 OVERLOOK DR
AKRON OH
44314-3337
US

V. Phone/Fax

Practice location:
  • Phone: 330-780-6586
  • Fax:
Mailing address:
  • Phone: 330-780-6586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number106S00000X
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: