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NPI Code Detail

MEDICARE: AMBROSE ODIARI QMHS MA

MEDICARE: AMBROSE ODIARI QMHS MA
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1801385901
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMBROSE ODIARI QMHS MA
Provider Business Mailing Address
First Line : 434 EASTLAND RD
Second Line :
City : BEREA
State : OH
Zip : 44017-1217
Country : US
Telephone Number : 440-234-2006
Fax Number :
Provider Business Practice Location Address
First Line : 500 MADISON AVE STE 335
Second Line :
City : TOLEDO
State : OH
Zip : 43604-1222
Country : US
Telephone Number : 440-260-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2018
Last Update Date : 05/03/2018

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