Healthcare Provider Details

I. General information

NPI: 1477234821
Provider Name (Legal Business Name): INTERACTIVE HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 W WALNUT AVE
PAINESVILLE OH
44077-2952
US

IV. Provider business mailing address

916 BALBOA CT
PAINESVILLE OH
44077-5374
US

V. Phone/Fax

Practice location:
  • Phone: 440-223-5659
  • Fax:
Mailing address:
  • Phone: 440-223-5659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DEIRDRE D RAIMEY
Title or Position: CERTIFIED NURSE PRACTITIONER
Credential: DNP, APRN
Phone: 440-223-5659