Healthcare Provider Details

I. General information

NPI: 1982326989
Provider Name (Legal Business Name): TIAERRIA NICOLE SMILEY QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38465 NORTH LN APT A210
WILLOUGHBY OH
44094-7483
US

IV. Provider business mailing address

13422 KINSMAN RD
CLEVELAND OH
44120-4410
US

V. Phone/Fax

Practice location:
  • Phone: 216-703-9103
  • Fax:
Mailing address:
  • Phone: 216-283-4400
  • Fax: 216-283-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: