Healthcare Provider Details

I. General information

NPI: 1285578161
Provider Name (Legal Business Name): JOEL R KING
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 N HUNTINGTON ST APT 303
MEDINA OH
44256-3160
US

IV. Provider business mailing address

699 N HUNTINGTON ST APT 303
MEDINA OH
44256-3160
US

V. Phone/Fax

Practice location:
  • Phone: 216-924-0390
  • Fax:
Mailing address:
  • Phone: 216-924-0390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberRP342364
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: