Healthcare Provider Details

I. General information

NPI: 1033070982
Provider Name (Legal Business Name): ANGELA GOBER-WOODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 BRIDGE AVE
CLEVELAND OH
44113-3304
US

IV. Provider business mailing address

4115 BRIDGE AVE
CLEVELAND OH
44113-3304
US

V. Phone/Fax

Practice location:
  • Phone: 216-631-5800
  • Fax: 216-631-4595
Mailing address:
  • Phone: 216-631-5800
  • Fax: 216-631-4595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: