MEDICARE: MISS MARY C HOLLINS MA, CDCA

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1093256489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARY C HOLLINS MA, CDCA

Provider Business Mailing Address
First Line	:	4401 ROCKSIDE RD STE 401
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2147
Country	:	US
Telephone Number	:	239-009-0473
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 ROCKSIDE RD STE 401
Second Line	:
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-2147
Country	:	US
Telephone Number	:	239-009-0473
Fax Number	:	216-432-7259

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

Provider Enumeration Date	:	03/17/2017
Last Update Date	:	11/25/2022

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