Healthcare Provider Details

I. General information

NPI: 1497648455
Provider Name (Legal Business Name): GLORIA WATSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9123 INMAN AVE
CLEVELAND OH
44105-2107
US

IV. Provider business mailing address

9123 INMAN AVE
CLEVELAND OH
44105-2107
US

V. Phone/Fax

Practice location:
  • Phone: 216-203-2157
  • Fax:
Mailing address:
  • Phone: 216-203-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: