Healthcare Provider Details

I. General information

NPI: 1184383135
Provider Name (Legal Business Name): PATRICK O OKOROAFOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36455 PETTIBONE RD
SOLON OH
44139-5104
US

IV. Provider business mailing address

4350 ROCKY RIVER DR
CLEVELAND OH
44135-2504
US

V. Phone/Fax

Practice location:
  • Phone: 216-672-8981
  • Fax:
Mailing address:
  • Phone: 216-672-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: