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General NPI Number Information
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NPI Number | 1144470634
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Entity Type | Organization
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Legal Business Name | TONI GAMBLE
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 3545 E 105TH ST
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City | CLEVELAND
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State | OH
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Zip | 44105-1815
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Country | US
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Telephone | 216-441-4585
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Fax |
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Provider Business Mailing Address
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Address Line | 3545 E 105TH ST
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City | CLEVELAND
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State | OH
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Zip | 44105-1815
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Country | US
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Telephone | 216-441-4585
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Fax |
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Authorized Official
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Title or Position | LICENSED PRACTICTIO
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Name | MS. TONI TEKILA GAMBLE
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Credential | LPN
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Telephone | 216-441-4585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number | 130161
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License Number State | OH
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