MEDICARE: COURTNEY SPEED

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	251J00000X	Nursing Care Agency	150548	OH

General Provider Information

NPI Number	:	1669892196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURTNEY SPEED

Provider Business Mailing Address
First Line	:	19101 SHAWNEE AVE.
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119
Country	:	US
Telephone Number	:	216-970-4870
Fax Number	:

Provider Business Practice Location Address
First Line	:	19101 SHAWNEE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44119-2715
Country	:	US
Telephone Number	:	216-970-4870
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PRACTICAL NURSE
Name	:	MS. COURTNEY LYNNE SPEED
Credential	:	LPN
Telephone Number	:	216-970-4870

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	04/23/2014

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