Healthcare Provider Details

I. General information

NPI: 1053035055
Provider Name (Legal Business Name): MRS. CHRISTINE MARIE HEED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5162 GLENMOORE WAY
MEDINA OH
44256-6838
US

IV. Provider business mailing address

5162 GLENMOORE WAY
MEDINA OH
44256-6838
US

V. Phone/Fax

Practice location:
  • Phone: 216-544-0684
  • Fax:
Mailing address:
  • Phone: 216-544-0684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: