MEDICARE: ARCHELLE BLOODWORTH

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	374U00000X	Home Health Aide
3	376K00000X	Nurse's Aide
4	372600000X	Adult Companion

General Provider Information

NPI Number	:	1487390472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARCHELLE BLOODWORTH

Provider Business Mailing Address
First Line	:	3038 E 130TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-3006
Country	:	US
Telephone Number	:	216-413-2996
Fax Number	:

Provider Business Practice Location Address
First Line	:	3038 E 130TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-3006
Country	:	US
Telephone Number	:	216-413-2996
Fax Number	:

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

Provider Enumeration Date	:	05/11/2022
Last Update Date	:	06/03/2024

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Directions to “ ARCHELLE BLOODWORTH ” Practice Location

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