Healthcare Provider Details

I. General information

NPI: 1396583290
Provider Name (Legal Business Name): LENTRAIL ABSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3622 PROSPECT AVE E
CLEVELAND OH
44115-2704
US

IV. Provider business mailing address

111 E 204TH ST
EUCLID OH
44123-1048
US

V. Phone/Fax

Practice location:
  • Phone: 216-431-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: