MEDICARE: AIRIAN PRUITT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1013545524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIRIAN PRUITT

Provider Business Mailing Address
First Line	:	6350 SPARROWHAWK WAY
Second Line	:
City	:	OAKWOOD VILLAGE
State	:	OH
Zip	:	44146-3166
Country	:	US
Telephone Number	:	216-526-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	17325 EUCLID AVE STE 4103
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1262
Country	:	US
Telephone Number	:	216-526-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	06/03/2020

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Directions to “ AIRIAN PRUITT ” Practice Location

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