MEDICARE: JENICE COLLINS INDEPENDENT SERVICE

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	171W00000X	Contractor
2	171M00000X	Case Manager/Care Coordinator

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	:	1306380738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENICE COLLINS INDEPENDENT SERVICE

Provider Business Mailing Address
First Line	:	423 EDDY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1754
Country	:	US
Telephone Number	:	216-848-9115
Fax Number	:

Provider Business Practice Location Address
First Line	:	423 EDDY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1754
Country	:	US
Telephone Number	:	216-848-9115
Fax Number	:

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

Provider Enumeration Date	:	12/04/2016
Last Update Date	:	10/18/2023

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