MEDICARE: DEMEKA TYUS

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		OH

General Provider Information

NPI Number	:	1881468015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEMEKA TYUS

Provider Business Mailing Address
First Line	:	2126 W 103RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3507
Country	:	US
Telephone Number	:	440-558-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	2126 W 103RD ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3507
Country	:	US
Telephone Number	:	440-558-8444
Fax Number	:

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

Provider Enumeration Date	:	11/08/2023
Last Update Date	:	11/08/2023

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