Healthcare Provider Details

I. General information

NPI: 1649728619
Provider Name (Legal Business Name): EXPRESSIVE HEALTHCARE ACADEMY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4479 BROADVIEW RD
CLEVELAND OH
44109-4302
US

IV. Provider business mailing address

4479 BROADVIEW RD
CLEVELAND OH
44109-4302
US

V. Phone/Fax

Practice location:
  • Phone: 216-916-9282
  • Fax:
Mailing address:
  • Phone: 216-916-9282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateOH

VIII. Authorized Official

Name: MS. KATHLEEN DAWELLA MOSLEY
Title or Position: OWNER
Credential:
Phone: 216-916-9282