Healthcare Provider Details

I. General information

NPI: 1871365742
Provider Name (Legal Business Name): MAGDALYS GRILLO RIVERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 10/28/2023
Certification Date: 10/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3717 GERMAINE AVE
CLEVELAND OH
44109-5044
US

IV. Provider business mailing address

3717 GERMAINE AVE
CLEVELAND OH
44109-5044
US

V. Phone/Fax

Practice location:
  • Phone: 216-255-7839
  • Fax:
Mailing address:
  • Phone: 216-255-7839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: