Healthcare Provider Details

I. General information

NPI: 1780237172
Provider Name (Legal Business Name): KIMBERLY JOY HOSKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 12/29/2022
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 ANSEL RD
CLEVELAND OH
44108-3323
US

IV. Provider business mailing address

1320 WASHINGTON AVE
CLEVELAND OH
44113-2333
US

V. Phone/Fax

Practice location:
  • Phone: 440-719-9911
  • Fax:
Mailing address:
  • Phone: 216-781-0550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number173882.CDCA
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number001205
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: