Healthcare Provider Details

I. General information

NPI: 1235309717
Provider Name (Legal Business Name): MRS. JENNIFER JUANITA CROOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER JUANITA MUNN

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1724 TAYLOR RD APT 1
EAST CLEVELAND OH
44112-2888
US

IV. Provider business mailing address

1724 TAYLOR RD APT 1
EAST CLEVELAND OH
44112-2888
US

V. Phone/Fax

Practice location:
  • Phone: 216-212-1015
  • Fax: 216-851-2781
Mailing address:
  • Phone: 216-212-1015
  • Fax: 216-851-2781

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 Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: