Healthcare Provider Details

I. General information

NPI: 1871217851
Provider Name (Legal Business Name): RASHIDA KHALILAH THIGPEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3040 S MORELAND BLVD APT 5
CLEVELAND OH
44120-6001
US

IV. Provider business mailing address

3040 S MORELAND BLVD APT 5
CLEVELAND OH
44120-6001
US

V. Phone/Fax

Practice location:
  • Phone: 216-324-0362
  • Fax:
Mailing address:
  • Phone: 216-324-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: