MEDICARE: CEDRIC J MCCLENDON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171W00000X	Contractor
2	172A00000X	Driver
3	225800000X	Recreation Therapist
4	374U00000X	Home Health Aide
5	372600000X	Adult Companion
6	372500000X	Chore Provider

General Provider Information

NPI Number	:	1407539497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CEDRIC J MCCLENDON

Provider Business Mailing Address
First Line	:	2105 ALPENA AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-2635
Country	:	US
Telephone Number	:	937-604-6741
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 ALPENA AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-2635
Country	:	US
Telephone Number	:	937-604-6741
Fax Number	:

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

Provider Enumeration Date	:	08/08/2023
Last Update Date	:	08/08/2023

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Directions to “ CEDRIC J MCCLENDON ” Practice Location

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