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NPI Code Detail

MEDICARE: KIMBERLEY YVETTE GREEN

MEDICARE: KIMBERLEY YVETTE GREEN
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
1324500000XSubstance Abuse Rehabilitation Facility3245000000XOH

General Provider Information

NPI Number : 1891377586
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLEY YVETTE GREEN
Provider Business Mailing Address
First Line : 3303 BERKSHIRE RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44118-2526
Country : US
Telephone Number : 216-322-7841
Fax Number :
Provider Business Practice Location Address
First Line : 3303 BERKSHIRE RD
Second Line :
City : CLEVELAND HEIGHTS
State : OH
Zip : 44118-2526
Country : US
Telephone Number : 216-322-7841
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2021
Last Update Date : 04/22/2021

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Directions to “ KIMBERLEY YVETTE GREEN ” Practice Location

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