Healthcare Provider Details

I. General information

NPI: 1902533482
Provider Name (Legal Business Name): NIA BASS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 EUCLID AVE
EUCLID OH
44117-1521
US

IV. Provider business mailing address

224 E 216TH ST
EUCLID OH
44123-1724
US

V. Phone/Fax

Practice location:
  • Phone: 855-967-2436
  • Fax:
Mailing address:
  • Phone: 216-327-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number181155
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: