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General NPI Number Information
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NPI Number | 1912863531
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Entity Type | Individual
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Provider Name | MALIK OMAR EVANS
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Gender | Male
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 726 E 185TH ST
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City | CLEVELAND
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State | OH
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Zip | 44119-2172
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Country | US
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Telephone | 440-903-9591
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Fax |
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Provider Business Mailing Address
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Address Line | 3645 LUDGATE RD
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44120-5069
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Country | US
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Telephone | 440-903-9591
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | OH
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