Healthcare Provider Details

I. General information

NPI: 1750686630
Provider Name (Legal Business Name): GERIATRIC HEALTH EXCELLENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD SUITE 328
CLEVELAND OH
44104-3869
US

IV. Provider business mailing address

PO BOX 77043
CLEVELAND OH
44194-7043
US

V. Phone/Fax

Practice location:
  • Phone: 216-881-5055
  • Fax: 216-881-5855
Mailing address:
  • Phone: 216-472-2730
  • Fax: 216-472-2740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCOA11665-NP
License Number StateOH

VIII. Authorized Official

Name: DONNA PIERCE
Title or Position: NP / OWNER
Credential: NP
Phone: 216-881-5055