Healthcare Provider Details

I. General information

NPI: 1619544970
Provider Name (Legal Business Name): SOPHIA L DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3765 MARTIN LUTHER KING JR DR
CLEVELAND OH
44105-2867
US

IV. Provider business mailing address

3765 MARTIN LUTHER KING JR DR
CLEVELAND OH
44105-2867
US

V. Phone/Fax

Practice location:
  • Phone: 216-246-7272
  • Fax:
Mailing address:
  • Phone: 216-246-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: