Healthcare Provider Details

I. General information

NPI: 1457142507
Provider Name (Legal Business Name): VIRGINIA DARLENE DAWSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/17/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 E 95TH ST
CLEVELAND OH
44108-1222
US

IV. Provider business mailing address

767 E 95TH ST
CLEVELAND OH
44108-1222
US

V. Phone/Fax

Practice location:
  • Phone: 216-269-8467
  • Fax:
Mailing address:
  • Phone: 216-269-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number9437817734VD
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: