Healthcare Provider Details

I. General information

NPI: 1760136790
Provider Name (Legal Business Name): HEAVEN MORRIS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2079 GREEN RD
CLEVELAND OH
44121-1109
US

IV. Provider business mailing address

2079 GREEN RD
CLEVELAND OH
44121-1109
US

V. Phone/Fax

Practice location:
  • Phone: 216-338-7140
  • Fax:
Mailing address:
  • Phone: 216-338-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: