Healthcare Provider Details

I. General information

NPI: 1558965061
Provider Name (Legal Business Name): SONNYTTA JARVA MOYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SONNYTTA JARVA MOYE STNA

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 W 49TH ST
CLEVELAND OH
44102-6042
US

IV. Provider business mailing address

3460 W 49TH ST
CLEVELAND OH
44102-6042
US

V. Phone/Fax

Practice location:
  • Phone: 216-355-7079
  • Fax:
Mailing address:
  • Phone: 216-355-7079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number371865550197
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: