Healthcare Provider Details

I. General information

NPI: 1730925363
Provider Name (Legal Business Name): ASHLEY MCILVAINE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10427 DETROIT AVE
CLEVELAND OH
44102-1645
US

IV. Provider business mailing address

10427 DETROIT AVE
CLEVELAND OH
44102-1645
US

V. Phone/Fax

Practice location:
  • Phone: 216-307-5836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411252
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: