MEDICARE: ENRICHING INNOVATIONS INC

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	164W00000X	Licensed Practical Nurse	PN092715	OH

General Provider Information

NPI Number	:	1548224785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENRICHING INNOVATIONS INC

Provider Business Mailing Address
First Line	:	1220 S BELVOIR BLVD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2949
Country	:	US
Telephone Number	:	216-382-9547
Fax Number	:	216-381-9517

Provider Business Practice Location Address
First Line	:	1220 S BELVOIR BLVD
Second Line	:
City	:	SOUTH EUCLID
State	:	OH
Zip	:	44121-2949
Country	:	US
Telephone Number	:	216-382-9547
Fax Number	:	216-381-9517

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SANDY LEE RIDER
Credential	:	LPN
Telephone Number	:	216-382-9547

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	08/22/2020

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