Healthcare Provider Details

I. General information

NPI: 1053160929
Provider Name (Legal Business Name): U B & TEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37850 EUCLID AVE APT 2
WILLOUGHBY OH
44094-5988
US

IV. Provider business mailing address

2400 LOST NATION RD
WILLOUGHBY OH
44094-7536
US

V. Phone/Fax

Practice location:
  • Phone: 440-667-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: ALANA MILLER
Title or Position: COO
Credential:
Phone: 440-667-8700