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General NPI Number Information
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NPI Number | 1235003096
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Entity Type | Individual
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Provider Name | VICTORIA ALEXANDRIA VICKERSTAFF
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Gender | Female
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Dates
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Enumeration Date | 10/03/2025
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Last Update Date | 10/03/2025
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Provider Practice Location Address
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Address Line | 12110 LEEILA AVE
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City | CLEVELAND
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State | OH
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Zip | 44135-4720
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Country | US
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Telephone | 216-484-3209
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Fax |
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Provider Business Mailing Address
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Address Line | 12110 LEEILA AVE
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City | CLEVELAND
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State | OH
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Zip | 44135-4720
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Country | US
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Telephone | 216-484-3209
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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 | 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 | OH
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 331L00000X
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Taxonomy Name | Blood Bank
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License Number |
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State | OH
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Taxonomy #6
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State | OH
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Taxonomy #7
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State | OH
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Taxonomy #8
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State | OH
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Taxonomy #9
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number |
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License Number State | OH
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Taxonomy #10
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State | OH
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Taxonomy #11
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State | OH
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