Healthcare Provider Details

I. General information

NPI: 1619647922
Provider Name (Legal Business Name): BRANDI A GLOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 09/17/2021
Certification Date: 09/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 MCCRACKEN RD
CLEVELAND OH
44125-2967
US

IV. Provider business mailing address

12395 MCCRACKEN RD STE A-UP
CLEVELAND OH
44125-2967
US

V. Phone/Fax

Practice location:
  • Phone: 216-587-6727
  • Fax:
Mailing address:
  • Phone: 216-338-6470
  • 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: