MEDICARE: MS. TA'LIYAH MONTANA

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	343900000X	Non-emergency Medical Transport (VAN)
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1174386403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TA'LIYAH MONTANA

Provider Business Mailing Address
First Line	:	503 E 200TH ST STE 103
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44119-1562
Country	:	US
Telephone Number	:	216-978-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 E 200TH ST STE 103
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44119-1562
Country	:	US
Telephone Number	:	216-978-0386
Fax Number	:

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

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	03/03/2026

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