MEDICARE: MONIQUE

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	251E00000X	Home Health Agency	501053061205	OH

General Provider Information

NPI Number	:	1831401025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONIQUE

Provider Business Mailing Address
First Line	:	1145 E 168TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-1557
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1145 E 168TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44110-1557
Country	:	US
Telephone Number	:	216-399-4010
Fax Number	:

Authorized Official
Title or Position	:	INDEPENDENT PROVIDER
Name	:	MONIQUE RENEE TERRY
Credential	:
Telephone Number	:	216-339-4010

Provider Enumeration Date	:	07/05/2010
Last Update Date	:	07/05/2010

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Directions to “MONIQUE ” Practice Location

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