Healthcare Provider Details

I. General information

NPI: 1780346080
Provider Name (Legal Business Name): DEMETRIA LOUISE EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3439 E 121ST ST
CLEVELAND OH
44120-4301
US

IV. Provider business mailing address

3439 E 121ST ST
CLEVELAND OH
44120-4301
US

V. Phone/Fax

Practice location:
  • Phone: 216-372-1731
  • Fax:
Mailing address:
  • Phone: 216-372-1731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24-354836
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number123326789
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: