MEDICARE: CHRISTAL DIANA DAVIS

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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1508613779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTAL DIANA DAVIS

Provider Business Mailing Address
First Line	:	20441 WESTPORT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44123-2835
Country	:	US
Telephone Number	:	216-246-1706
Fax Number	:

Provider Business Practice Location Address
First Line	:	20441 WESTPORT AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44123-2835
Country	:	US
Telephone Number	:	216-246-1706
Fax Number	:

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

Provider Enumeration Date	:	05/04/2024
Last Update Date	:	05/04/2024

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Directions to “ CHRISTAL DIANA DAVIS ” Practice Location

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