Healthcare Provider Details

I. General information

NPI: 1063108249
Provider Name (Legal Business Name): TIFFANY LAVERNE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6509 SOUTHFIELD AVE
CLEVELAND OH
44144-1742
US

IV. Provider business mailing address

6509 SOUTHFIELD AVE
CLEVELAND OH
44144-1742
US

V. Phone/Fax

Practice location:
  • Phone: 216-801-8440
  • Fax:
Mailing address:
  • Phone: 216-801-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: