MEDICARE: MR. JOSEPH MITHELL

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	374U00000X	Home Health Aide	2772405	OH

General Provider Information

NPI Number	:	1922791318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH MITHELL

Provider Business Mailing Address
First Line	:	6719 BIG CREEK PKWY
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44130-2602
Country	:	US
Telephone Number	:	440-478-6770
Fax Number	:

Provider Business Practice Location Address
First Line	:	2671 BRAMBLEWOOD DR
Second Line	:
City	:	BROADVIEW HEIGHTS
State	:	OH
Zip	:	44147-2003
Country	:	US
Telephone Number	:	440-478-6770
Fax Number	:

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

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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