MEDICARE: XAVIER ANDRU JA'CEI CLOUD

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	106S00000X	Behavior Technician		OH

General Provider Information

NPI Number	:	1174269120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	XAVIER ANDRU JA'CEI CLOUD

Provider Business Mailing Address
First Line	:	1744 PAYNE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-2910
Country	:	US
Telephone Number	:	216-623-6555
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S MAIN ST
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-2055
Country	:	US
Telephone Number	:	937-599-7235
Fax Number	:

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	02/03/2026

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