Healthcare Provider Details

I. General information

NPI: 1104565712
Provider Name (Legal Business Name): JAUNEECE S ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 CLIFFVIEW RD # 2
CLEVELAND OH
44112-1110
US

IV. Provider business mailing address

19400 NYACK CT
CLEVELAND OH
44110-2734
US

V. Phone/Fax

Practice location:
  • Phone: 216-548-7217
  • Fax:
Mailing address:
  • Phone: 216-548-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.005752
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: