Healthcare Provider Details

I. General information

NPI: 1245747450
Provider Name (Legal Business Name): JOYNELL A VISION OF HEALTH AND WELLNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 SHAKER BLVD
CLEVELAND OH
44120-1931
US

IV. Provider business mailing address

11811 SHAKER BLVD STE 123
CLEVELAND OH
44120-1927
US

V. Phone/Fax

Practice location:
  • Phone: 216-965-6325
  • Fax: 216-242-2990
Mailing address:
  • Phone: 216-965-6325
  • Fax: 216-242-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE HARRIS
Title or Position: CEO
Credential: APRN, NP-C
Phone: 216-965-6325