MEDICARE: FISHER OF MEN ENTERTAINMENT, LLC

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1548126931
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FISHER OF MEN ENTERTAINMENT, LLC

Provider Business Mailing Address
First Line	:	25895 FORBES RD
Second Line	:
City	:	OAKWOOD VILLAGE
State	:	OH
Zip	:	44146-5605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 HAYDEN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-3538
Country	:	US
Telephone Number	:	216-324-1599
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATASHA WATTS
Credential	:
Telephone Number	:	216-324-1599

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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