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General NPI Number Information
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NPI Number | 1457009623
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Entity Type | Individual
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Provider Name | TIFFANY ALLEN ALLEN STNA
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Gender | Female
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Dates
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Enumeration Date | 03/16/2022
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 10808 CHURCHILL AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1211
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Country | US
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Telephone | 216-323-0646
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Fax |
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Provider Business Mailing Address
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Address Line | 409 W GRACE ST
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City | BEDFORD
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State | OH
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Zip | 44146-3256
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Country | US
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Telephone | 216-323-0646
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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 | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number | 038232
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 321476071197
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License Number State | OH
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