Healthcare Provider Details

I. General information

NPI: 1811721988
Provider Name (Legal Business Name): TANIYA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4286 E 162ND ST
CLEVELAND OH
44128-2461
US

IV. Provider business mailing address

4286 E 162ND ST
CLEVELAND OH
44128-2461
US

V. Phone/Fax

Practice location:
  • Phone: 216-530-3933
  • Fax:
Mailing address:
  • Phone: 216-530-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: