Healthcare Provider Details

I. General information

NPI: 1326448648
Provider Name (Legal Business Name): DELCENIA KIMBROUGH CARE COORDINATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 MIDWAY BLVD
ELYRIA OH
44035-9006
US

IV. Provider business mailing address

1417 KIMBERLY CT
LORAIN OH
44053-3512
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-5555
  • Fax:
Mailing address:
  • Phone: 410-670-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: