MEDICARE: JEAN HOMRIGHAUSEN LISW

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	104100000X	Social Worker	I.0005392-SUPV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164654026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN HOMRIGHAUSEN LISW

Provider Business Mailing Address
First Line	:	13201 GRANGER RD STE GARFIELD
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-1978
Country	:	US
Telephone Number	:	216-831-2255
Fax Number	:	216-378-3906

Provider Business Practice Location Address
First Line	:	13201 GRANGER RD STE GARFIELD
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-1978
Country	:	US
Telephone Number	:	216-831-2255
Fax Number	:	216-378-3906

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

Provider Enumeration Date	:	08/11/2009
Last Update Date	:	09/09/2024

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Directions to “ JEAN HOMRIGHAUSEN LISW” Practice Location

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