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General NPI Number Information
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NPI Number | 1598151904
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Entity Type | Organization
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Legal Business Name | HOMELESS W INCOME
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3323 W 25TH ST
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City | CLEVELAND
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State | OH
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Zip | 44109-1691
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Country | US
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Telephone | 216-456-0306
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Fax |
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Provider Business Mailing Address
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Address Line | 3323 W 25TH ST
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City | CLEVELAND
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State | OH
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Zip | 44109-1691
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Country | US
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Telephone | 216-456-0306
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Fax |
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Authorized Official
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Title or Position | 0WNER
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Name | MS. TRONA DAVIS
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Credential |
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Telephone | 216-456-0306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 302F00000X
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 305R00000X
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License Number State |
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Taxonomy #3
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State | OH
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