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General NPI Number Information
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NPI Number | 1619543857
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Entity Type | Individual
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Provider Name | ELLIOTT ALLEN HHA
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Gender | Male
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Dates
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Enumeration Date | 05/28/2021
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 14630 PURITAS AVE APT 202
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City | CLEVELAND
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State | OH
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Zip | 44135-2848
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Country | US
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Telephone | 216-269-7935
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Fax |
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Provider Business Mailing Address
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Address Line | 14039 PURITAS AVENUE PO BOX 35438
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City | CLEVELAND
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State | OH
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Zip | 44135-0438
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Country | US
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Telephone |
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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