MEDICARE: GODDESSES BLESSING GODDESSES

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1083032650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GODDESSES BLESSING GODDESSES

Provider Business Mailing Address
First Line	:	3300 E 55TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1529
Country	:	US
Telephone Number	:	216-502-0082
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 E 55TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1529
Country	:	US
Telephone Number	:	216-502-0082
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. LADONNA BLAYLOCK
Credential	:
Telephone Number	:	216-502-0082

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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Directions to “GODDESSES BLESSING GODDESSES ” Practice Location

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