Healthcare Provider Details

I. General information

NPI: 1831776210
Provider Name (Legal Business Name): CORY MICHAEL HAYWOOD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 EAST 57TH STREET
CLEVELAND OH
44105-3306
US

IV. Provider business mailing address

3709 E. 57 STREET
CLEVELAND OH
44105-3306
US

V. Phone/Fax

Practice location:
  • Phone: 216-326-0603
  • Fax:
Mailing address:
  • Phone: 216-326-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: