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NPI Code Detail

MEDICARE: SAMATHA PORTER QMHS, CDCA

MEDICARE: SAMATHA PORTER QMHS, 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1154828192
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMATHA PORTER QMHS, CDCA
Provider Business Mailing Address
First Line : 4300 LYNN RD STE 201
Second Line :
City : RAVENNA
State : OH
Zip : 44266-7838
Country : US
Telephone Number : 216-264-0008
Fax Number :
Provider Business Practice Location Address
First Line : 4300 LYNN RD STE 201
Second Line :
City : RAVENNA
State : OH
Zip : 44266-7838
Country : US
Telephone Number : 216-264-0008
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2018
Last Update Date : 12/08/2025

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Directions to “ SAMATHA PORTER QMHS, CDCA” Practice Location

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