MEDICARE: JOSEPH LAVELLE HENDERSON

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1558130856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH LAVELLE HENDERSON

Provider Business Mailing Address
First Line	:	4440 SEXTON RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-6005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 SEXTON RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-6005
Country	:	US
Telephone Number	:	440-539-9782
Fax Number	:

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

Provider Enumeration Date	:	12/28/2023
Last Update Date	:	12/28/2023

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Directions to “ JOSEPH LAVELLE HENDERSON ” Practice Location

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