Healthcare Provider Details

I. General information

NPI: 1720849383
Provider Name (Legal Business Name): QUTIE AND THE BEARDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 01/22/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1496 LAKEVIEW ST
LAKEMORE OH
44250-9593
US

IV. Provider business mailing address

1496 LAKEVIEW ST # 294
LAKEMORE OH
44250-9593
US

V. Phone/Fax

Practice location:
  • Phone: 440-444-7363
  • Fax:
Mailing address:
  • Phone: 440-444-7363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: QUISHELLE L SHELTON
Title or Position: OWNER
Credential:
Phone: 440-444-7363