Healthcare Provider Details

I. General information

NPI: 1083109276
Provider Name (Legal Business Name): LAREDA J HASLEM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2018
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 CLEMENT AVE APT 1
CLEVELAND OH
44105-5033
US

IV. Provider business mailing address

7130 CLEMENT AVE APT 1
CLEVELAND OH
44105-5033
US

V. Phone/Fax

Practice location:
  • Phone: 330-208-6648
  • Fax:
Mailing address:
  • Phone: 330-208-6648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
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: