Healthcare Provider Details

I. General information

NPI: 1437552262
Provider Name (Legal Business Name): ANITA DOOMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4735 WALFORD RD # 16
CLEVELAND OH
44128-5125
US

IV. Provider business mailing address

4735 WALFORD RD # 16
CLEVELAND OH
44128-5125
US

V. Phone/Fax

Practice location:
  • Phone: 216-776-8349
  • Fax:
Mailing address:
  • Phone: 216-776-8349
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number150288
License Number StateOH

VIII. Authorized Official

Name: ANITA DOOMS
Title or Position: LPN
Credential:
Phone: 216-776-8349