Healthcare Provider Details

I. General information

NPI: 1023573623
Provider Name (Legal Business Name): ANTOINETTE BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 E 134TH ST
CLEVELAND OH
44120-3227
US

IV. Provider business mailing address

3221 E 134TH ST
CLEVELAND OH
44120-3227
US

V. Phone/Fax

Practice location:
  • Phone: 216-209-4558
  • Fax:
Mailing address:
  • Phone: 216-209-4558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number401210450311
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number401210450311
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number401210450311
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: