Healthcare Provider Details

I. General information

NPI: 1013637487
Provider Name (Legal Business Name): ANNTIONETTE CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9820 SOUTH BLVD
CLEVELAND OH
44108-3436
US

IV. Provider business mailing address

9820 SOUTH BLVD
CLEVELAND OH
44108-3436
US

V. Phone/Fax

Practice location:
  • Phone: 440-381-7036
  • Fax:
Mailing address:
  • Phone: 440-381-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401441930912
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: