MEDICARE: JEROME CASTLEBERRY

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1265160725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME CASTLEBERRY

Provider Business Mailing Address
First Line	:	4977 PENNY LANE
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070
Country	:	US
Telephone Number	:	216-855-7692
Fax Number	:

Provider Business Practice Location Address
First Line	:	3676 E 118TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-2558
Country	:	US
Telephone Number	:	216-776-8456
Fax Number	:

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

Provider Enumeration Date	:	08/11/2022
Last Update Date	:	08/11/2022

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Directions to “ JEROME CASTLEBERRY ” Practice Location

Language	Start Address	Practice Location

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