MEDICARE: EXSPENSIVE KNOWLES

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	253Z00000X	In Home Supportive Care Agency	0255489	OH

General Provider Information

NPI Number	:	1043812928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EXSPENSIVE KNOWLES

Provider Business Mailing Address
First Line	:	3397 W 99TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4642
Country	:	US
Telephone Number	:	216-925-7176
Fax Number	:

Provider Business Practice Location Address
First Line	:	3273 W 98TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-4601
Country	:	US
Telephone Number	:	216-925-7176
Fax Number	:

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

Provider Enumeration Date	:	11/14/2020
Last Update Date	:	11/14/2020

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Directions to “ EXSPENSIVE KNOWLES ” Practice Location

Language	Start Address	Practice Location

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