Healthcare Provider Details

I. General information

NPI: 1205215811
Provider Name (Legal Business Name): ESCHERICA MEDLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2015
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19218 SHAKERWOOD RD
WARRENSVILLE HEIGHTS OH
44122-6606
US

IV. Provider business mailing address

19218 SHAKERWOOD RD
WARRENSVILLE HEIGHTS OH
44122
US

V. Phone/Fax

Practice location:
  • Phone: 404-908-6040
  • Fax:
Mailing address:
  • Phone: 404-908-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number882062
License Number StateGA

VIII. Authorized Official

Name: ESCHERICA TIONNA MEDLEY
Title or Position: CNA
Credential:
Phone: 404-908-6040