Healthcare Provider Details

I. General information

NPI: 1669892196
Provider Name (Legal Business Name): COURTNEY SPEED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19101 SHAWNEE AVE
CLEVELAND OH
44119-2715
US

IV. Provider business mailing address

19101 SHAWNEE AVE.
CLEVELAND OH
44119
US

V. Phone/Fax

Practice location:
  • Phone: 216-970-4870
  • Fax:
Mailing address:
  • Phone: 216-970-4870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number150548
License Number StateOH

VIII. Authorized Official

Name: MS. COURTNEY LYNNE SPEED
Title or Position: LICENSED PRACTICAL NURSE
Credential: LPN
Phone: 216-970-4870