Healthcare Provider Details

I. General information

NPI: 1982190054
Provider Name (Legal Business Name): DONTE BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 E 120TH ST
CLEVELAND OH
44120-2121
US

IV. Provider business mailing address

3100 E 45TH ST STE 314
CLEVELAND OH
44127-1095
US

V. Phone/Fax

Practice location:
  • Phone: 213-374-8788
  • Fax:
Mailing address:
  • Phone: 216-441-9622
  • Fax: 888-460-4717

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: