Healthcare Provider Details

I. General information

NPI: 1033846613
Provider Name (Legal Business Name): SHAQWON BADLEY QMHS, CMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 12/03/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 GRANGER RD STE 8
GARFIELD HEIGHTS OH
44125-1979
US

IV. Provider business mailing address

13201 GRANGER RD
GARFIELD HEIGHTS OH
44125-1978
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-2255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: