=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093531469
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVELYN HAYES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2024
-----------------------------------------------------
Last Update Date | 12/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 CATHEDRAL LN APT 801
-----------------------------------------------------
City | CUYAHOGA FALLS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44223-1678
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-810-0165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1304 1/2 STEESE RD
-----------------------------------------------------
City | UNIONTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44685-7756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-810-0165
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------