MEDICARE: AKIMA NADINE GILLIAM HOME HEALTH AID

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1578135398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AKIMA NADINE GILLIAM HOME HEALTH AID

Provider Business Mailing Address
First Line	:	1530 E 115TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3902
Country	:	US
Telephone Number	:	216-681-5616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1530 E 115TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-3902
Country	:	US
Telephone Number	:	216-302-0159
Fax Number	:

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

Provider Enumeration Date	:	07/12/2021
Last Update Date	:	07/12/2021

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