Healthcare Provider Details

I. General information

NPI: 1316138431
Provider Name (Legal Business Name): JOHN ANTHONY POWELL SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 E 91ST ST
CLEVELAND OH
44108-1232
US

IV. Provider business mailing address

4511 ROCKSIDE RD STE 330
INDEPENDENCE OH
44131-2157
US

V. Phone/Fax

Practice location:
  • Phone: 216-451-0842
  • Fax:
Mailing address:
  • Phone: 216-901-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberOTA00860
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: