Healthcare Provider Details

I. General information

NPI: 1174195291
Provider Name (Legal Business Name): DAVITA HURD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/21/2022
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17301 RIDGETON DR
CLEVELAND OH
44128-3354
US

IV. Provider business mailing address

17301 RIDGETON DR
CLEVELAND OH
44128-3354
US

V. Phone/Fax

Practice location:
  • Phone: 216-386-3924
  • Fax:
Mailing address:
  • Phone: 216-386-3924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: