Healthcare Provider Details

I. General information

NPI: 1609481878
Provider Name (Legal Business Name): COLLEEN NOEL BIRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 10/11/2020
Certification Date: 10/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8912 SCHAEFFER ST
MENTOR OH
44060-5038
US

IV. Provider business mailing address

8912 SCHAEFFER ST
MENTOR OH
44060-5038
US

V. Phone/Fax

Practice location:
  • Phone: 440-399-9612
  • Fax:
Mailing address:
  • Phone: 440-339-9612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: