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General NPI Number Information
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NPI Number | 1104622026
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Entity Type | Individual
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Provider Name | CHEYENNE HOLOMON
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Gender | Female
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Dates
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Enumeration Date | 02/21/2025
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 2785 SOM CENTER RD
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City | WILLOUGHBY HILLS
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State | OH
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Zip | 44094-6501
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Country | US
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Telephone | 216-278-0288
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Fax |
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Provider Business Mailing Address
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Address Line | 418 E 200TH ST
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City | EUCLID
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State | OH
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Zip | 44119-1564
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Country | US
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Telephone | 440-616-0468
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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