Healthcare Provider Details

I. General information

NPI: 1821595125
Provider Name (Legal Business Name): RENATA D. WEAVER QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13422 KINSMAN RD
CLEVELAND OH
44120-4410
US

IV. Provider business mailing address

9915 ORLEANS AVE
CLEVELAND OH
44105-2233
US

V. Phone/Fax

Practice location:
  • Phone: 216-283-4400
  • Fax:
Mailing address:
  • Phone: 216-798-9390
  • 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: