Healthcare Provider Details

I. General information

NPI: 1205431400
Provider Name (Legal Business Name): TASHONNA L PERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2020
Last Update Date: 10/30/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25300 COLUMBUS RD
BEDFORD HEIGHTS OH
44146
US

IV. Provider business mailing address

25300 COLUMBUS RD
BEDFORD HEIGHTS OH
44146
US

V. Phone/Fax

Practice location:
  • Phone: 216-203-8789
  • Fax:
Mailing address:
  • Phone: 216-203-8789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411584
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: