Healthcare Provider Details

I. General information

NPI: 1417451485
Provider Name (Legal Business Name): STEVEN PAUL SKORY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 03/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9540 COVE DR UNIT D4
NORTH ROYALTON OH
44133-2780
US

IV. Provider business mailing address

9540 COVE DR UNIT D4
NORTH ROYALTON OH
44133-2780
US

V. Phone/Fax

Practice location:
  • Phone: 510-290-6161
  • Fax:
Mailing address:
  • Phone: 510-290-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number0249610
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: