MEDICARE: MS. CHRISTINA CHRISTIAN

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1104305325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINA CHRISTIAN

Provider Business Mailing Address
First Line	:	14121 CHRISTINE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-6457
Country	:	US
Telephone Number	:	216-338-0235
Fax Number	:

Provider Business Practice Location Address
First Line	:	10708 KINSMAN RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-5360
Country	:	US
Telephone Number	:	216-338-0235
Fax Number	:

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

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	08/08/2018

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