MEDICARE: SOPHIA L DAVIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	172A00000X	Driver
3	343900000X	Non-emergency Medical Transport (VAN)
4	376J00000X	Homemaker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619544970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA L DAVIS

Provider Business Mailing Address
First Line	:	3765 MARTIN LUTHER KING JR DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-2867
Country	:	US
Telephone Number	:	216-246-7272
Fax Number	:

Provider Business Practice Location Address
First Line	:	3765 MARTIN LUTHER KING JR DR
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-2867
Country	:	US
Telephone Number	:	216-246-7272
Fax Number	:

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

Provider Enumeration Date	:	06/07/2021
Last Update Date	:	06/07/2021

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Directions to “ SOPHIA L DAVIS ” Practice Location

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