Healthcare Provider Details

I. General information

NPI: 1093286437
Provider Name (Legal Business Name): TENISHA NICHELLE MACK ABD, CDCA, CAMS-II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22639 EUCLID AVE
EUCLID OH
44117
US

IV. Provider business mailing address

5205 E 119TH ST
GARFIELD HEIGHTS OH
44125
US

V. Phone/Fax

Practice location:
  • Phone: 216-404-1900
  • Fax:
Mailing address:
  • Phone: 216-857-5463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: