Healthcare Provider Details

I. General information

NPI: 1225328479
Provider Name (Legal Business Name): MR. RALPH KENNETH MEADOWS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1358 W 61ST ST
CLEVELAND OH
44102-2104
US

IV. Provider business mailing address

1358 W 61ST ST
CLEVELAND OH
44102-2104
US

V. Phone/Fax

Practice location:
  • Phone: 216-521-6511
  • Fax: 216-521-6511
Mailing address:
  • Phone: 216-521-6511
  • Fax: 216-521-6511

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: