Healthcare Provider Details

I. General information

NPI: 1083303937
Provider Name (Legal Business Name): MARY MCNEAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUMMIT AVE APT 96
NILES OH
44446-3657
US

IV. Provider business mailing address

701 SUMMIT AVE APT 96
NILES OH
44446-3657
US

V. Phone/Fax

Practice location:
  • Phone: 330-314-3020
  • Fax:
Mailing address:
  • Phone: 330-314-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: