Healthcare Provider Details

I. General information

NPI: 1508658451
Provider Name (Legal Business Name): ANTHONY WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3122 WEST BLVD
CLEVELAND OH
44111-1849
US

IV. Provider business mailing address

3122 WEST BLVD
CLEVELAND OH
44111-1849
US

V. Phone/Fax

Practice location:
  • Phone: 216-551-0314
  • Fax:
Mailing address:
  • Phone: 216-551-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: