MEDICARE: GLORIA JEAN COLEMAN

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1093418253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA JEAN COLEMAN

Provider Business Mailing Address
First Line	:	PO BOX 23633
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44023-0633
Country	:	US
Telephone Number	:	440-570-2591
Fax Number	:

Provider Business Practice Location Address
First Line	:	3557 WASHINGTON BLVD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-2609
Country	:	US
Telephone Number	:	440-570-2591
Fax Number	:

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

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	03/24/2023

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Directions to “ GLORIA JEAN COLEMAN ” Practice Location

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