Healthcare Provider Details

I. General information

NPI: 1538865548
Provider Name (Legal Business Name): MARY B NEWCOMB CARE GIVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 09/29/2026
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8254 DEEPWOOD BLVD UNIT 14
MENTOR OH
44060-7747
US

IV. Provider business mailing address

8254 DEEPWOOD BLVD UNIT 14
MENTOR OH
44060-7747
US

V. Phone/Fax

Practice location:
  • Phone: 440-463-8025
  • Fax:
Mailing address:
  • Phone: 440-463-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: