Healthcare Provider Details

I. General information

NPI: 1558226860
Provider Name (Legal Business Name): OCTAVIA GILES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2349 COVENTRY RD
CLEVELAND HEIGHTS OH
44118-3548
US

IV. Provider business mailing address

2460 E 124TH ST
CLEVELAND OH
44120-1003
US

V. Phone/Fax

Practice location:
  • Phone: 216-229-4902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: