MEDICARE: DISHELL GRAYS

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1073113312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DISHELL GRAYS

Provider Business Mailing Address
First Line	:	3180 SYCAMORE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1828
Country	:	US
Telephone Number	:	216-910-8977
Fax Number	:

Provider Business Practice Location Address
First Line	:	3180 SYCAMORE RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1828
Country	:	US
Telephone Number	:	216-910-8977
Fax Number	:

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

Provider Enumeration Date	:	10/27/2020
Last Update Date	:	11/29/2020

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Directions to “ DISHELL GRAYS ” Practice Location

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