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General NPI Number Information
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NPI Number | 1417754193
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Entity Type | Individual
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Provider Name | HOLLY DAVENPORT
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Gender | Female
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 612 E 185TH ST
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City | CLEVELAND
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State | OH
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Zip | 44119-1766
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Country | US
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Telephone | 216-659-7610
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Fax |
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Provider Business Mailing Address
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Address Line | 1073 E 146TH ST
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City | CLEVELAND
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State | OH
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Zip | 44110-3315
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Country | US
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Telephone | 216-738-2265
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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 | RT692702
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License Number State | OH
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Taxonomy #2
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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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