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General NPI Number Information
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NPI Number | 1043047608
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Entity Type | Individual
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Provider Name | AMY POTILLO
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Gender | Female
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Dates
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Enumeration Date | 09/17/2024
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 16004 BROADWAY AVE
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City | MAPLE HEIGHTS
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State | OH
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Zip | 44137-2575
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Country | US
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Telephone | 216-269-1487
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Fax |
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Provider Business Mailing Address
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Address Line | 13314 CRANWOOD DR
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City | GARFIELD HTS
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State | OH
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Zip | 44105-6812
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Country | US
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Telephone | 216-269-1487
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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