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NPI Code Detail

MEDICARE: DOVE LEGACY HEALTH

MEDICARE: DOVE LEGACY HEALTH
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
1261QG0250XGenetics Clinic/Center
2261QM1300XMulti-Specialty Clinic/Center
3363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1437919776
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOVE LEGACY HEALTH
Provider Business Mailing Address
First Line : 14108 BECKET RD
Second Line :
City : SHAKER HTS
State : OH
Zip : 44120-2825
Country : US
Telephone Number : 216-262-0155
Fax Number :
Provider Business Practice Location Address
First Line : 16100 EUCLID AVE
Second Line :
City : EAST CLEVELAND
State : OH
Zip : 44112-1630
Country : US
Telephone Number : 216-200-6988
Fax Number :
Authorized Official
Title or Position : CEO
Name : KELLI LITTLEJOHN
Credential : DNP, FNPC
Telephone Number : 216-262-0155
Provider Enumeration Date : 03/21/2024
Last Update Date : 03/21/2024

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Directions to “DOVE LEGACY HEALTH ” Practice Location

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