MEDICARE: ANDRE JEROME MCCLAIN JR.

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	376J00000X	Homemaker	VA892352	OH

General Provider Information

NPI Number	:	1194531756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRE JEROME MCCLAIN JR.

Provider Business Mailing Address
First Line	:	4207 GREEN CT
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-1127
Country	:	US
Telephone Number	:	216-357-9920
Fax Number	:

Provider Business Practice Location Address
First Line	:	4207 GREEN CT
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-1127
Country	:	US
Telephone Number	:	216-357-9920
Fax Number	:

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

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	12/09/2024

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