Healthcare Provider Details

I. General information

NPI: 1255185146
Provider Name (Legal Business Name): KIMBERLY ANN RIVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 214TH ST
EUCLID OH
44123-1742
US

IV. Provider business mailing address

240 E 214TH ST
EUCLID OH
44123-1742
US

V. Phone/Fax

Practice location:
  • Phone: 216-337-0280
  • Fax:
Mailing address:
  • Phone: 216-337-0280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number0210368
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: