Healthcare Provider Details

I. General information

NPI: 1831026061
Provider Name (Legal Business Name): LADY GODIVA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 BURNSIDE AVE
CLEVELAND OH
44110-2910
US

IV. Provider business mailing address

16600 BURNSIDE AVE
CLEVELAND OH
44110-2910
US

V. Phone/Fax

Practice location:
  • Phone: 216-246-8900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: KEYATTA BROWN
Title or Position: DIRECTOR
Credential:
Phone: 216-246-8900