MEDICARE: MRS. CHRISTINE ELAINE CANTILLON

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
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care

General Provider Information

NPI Number	:	1477372183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINE ELAINE CANTILLON

Provider Business Mailing Address
First Line	:	3838 BROOKSIDE BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111
Country	:	US
Telephone Number	:	216-251-0611
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 BROOKSIDE BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5105
Country	:	US
Telephone Number	:	216-251-0611
Fax Number	:

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

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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