Healthcare Provider Details

I. General information

NPI: 1215743752
Provider Name (Legal Business Name): DAISHA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E 111TH ST
CLEVELAND OH
44106-1303
US

IV. Provider business mailing address

136 PAUL ST
BEDFORD OH
44146-4646
US

V. Phone/Fax

Practice location:
  • Phone: 216-355-6703
  • Fax:
Mailing address:
  • Phone: 216-355-6703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License NumberRU850254
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: