MEDICARE: MARY SMITH-MOORE

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		OH

General Provider Information

NPI Number	:	1144155250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY SMITH-MOORE

Provider Business Mailing Address
First Line	:	11811 SHAKER BLVD STE 204
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11811 SHAKER BLVD STE 204
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1927
Country	:	US
Telephone Number	:	216-512-1859
Fax Number	:

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

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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Directions to “ MARY SMITH-MOORE ” Practice Location

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