Healthcare Provider Details

I. General information

NPI: 1760175632
Provider Name (Legal Business Name): TAMEKA DUBOIS CNA, HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 05/29/2023
Certification Date: 05/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10009 CUMBERLAND AVE
CLEVELAND OH
44104-3423
US

IV. Provider business mailing address

10009 CUMBERLAND AVE
CLEVELAND OH
44104-3423
US

V. Phone/Fax

Practice location:
  • Phone: 330-956-2310
  • Fax:
Mailing address:
  • Phone: 330-956-2310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: