Healthcare Provider Details

I. General information

NPI: 1356002521
Provider Name (Legal Business Name): RICHARDA LYNETTE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NOBLE DR
WOOSTER OH
44691-5353
US

IV. Provider business mailing address

2000 NOBLE DR
WOOSTER OH
44691-5353
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-3232
  • Fax:
Mailing address:
  • Phone: 330-264-3232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number3653006
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: