Healthcare Provider Details

I. General information

NPI: 1437623162
Provider Name (Legal Business Name): ANGENETTE HOLINESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date: 12/01/2020
Reactivation Date: 11/29/2022

III. Provider practice location address

22000 BALL AVE
EUCLID OH
44123-2706
US

IV. Provider business mailing address

22000 BALL AVE
EUCLID OH
44123-2706
US

V. Phone/Fax

Practice location:
  • Phone: 216-200-3821
  • Fax:
Mailing address:
  • Phone: 216-200-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: