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General NPI Number Information
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NPI Number | 1932524576
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Entity Type | Organization
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Legal Business Name | CASSONDRA HARRIS
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Dates
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Enumeration Date | 02/19/2014
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 17802 LAKE SHORE BLVD APT 4
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City | EUCLID
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State | OH
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Zip | 44119-1232
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Country | US
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Telephone | 216-694-1163
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Fax |
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Provider Business Mailing Address
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Address Line | 17802 LAKE SHORE BLVD APT 4
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City | EUCLID
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State | OH
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Zip | 44119-1232
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Country | US
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Telephone | 216-694-1163
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Fax |
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Authorized Official
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Title or Position | LPN
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Name | CASSONDRA HARRIS
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Credential |
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Telephone | 216-694-1163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | PN.130298
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License Number State | OH
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