MEDICARE: LAMARR DERRELL THORNTON

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	374U00000X	Home Health Aide
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1558217190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAMARR DERRELL THORNTON

Provider Business Mailing Address
First Line	:	3644 GROSVENOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3644 GROSVENOR RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-2631
Country	:	US
Telephone Number	:	216-396-3784
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ LAMARR DERRELL THORNTON ” Practice Location

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