Healthcare Provider Details

I. General information

NPI: 1902194988
Provider Name (Legal Business Name): MS. MARIA DENEEN MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3396 EAST 140TH
CLEVELAND OH
44120
US

IV. Provider business mailing address

3396 140TH
CLEVELAND OH
44120
US

V. Phone/Fax

Practice location:
  • Phone: 216-295-8408
  • Fax:
Mailing address:
  • Phone: 216-295-8408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: