Healthcare Provider Details

I. General information

NPI: 1538783923
Provider Name (Legal Business Name): DAJA NIKOLE STEARNES STNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 HEMLOCK DR
EUCLID OH
44132-2124
US

IV. Provider business mailing address

726 HEMLOCK DR
EUCLID OH
44132-2124
US

V. Phone/Fax

Practice location:
  • Phone: 216-512-4188
  • Fax:
Mailing address:
  • Phone: 216-512-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: