Healthcare Provider Details

I. General information

NPI: 1003776659
Provider Name (Legal Business Name): GLORIA CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/19/2025
Certification Date: 11/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SHELDON RD APT 430
BEREA OH
44017-1170
US

IV. Provider business mailing address

8233 CENTRAL AVE
CLEVELAND OH
44104-2119
US

V. Phone/Fax

Practice location:
  • Phone: 216-882-6128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: