MEDICARE: COLETTA MARIE ADAMS

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1760087423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLETTA MARIE ADAMS

Provider Business Mailing Address
First Line	:	28648 HOLLY DR
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-5138
Country	:	US
Telephone Number	:	440-785-0343
Fax Number	:	440-235-0125

Provider Business Practice Location Address
First Line	:	28648 HOLLY DR
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-5138
Country	:	US
Telephone Number	:	440-785-0343
Fax Number	:	440-235-0125

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

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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