MEDICARE: CHARLOTTE PHILLIPS

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	311ZA0620X	Adult Care Home Facility	RN352736	OH

General Provider Information

NPI Number	:	1982025433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLOTTE PHILLIPS

Provider Business Mailing Address
First Line	:	631 LEE RD
Second Line	:	APT 1210
City	:	BEDFORD
State	:	OH
Zip	:	44146-3496
Country	:	US
Telephone Number	:	216-450-0598
Fax Number	:

Provider Business Practice Location Address
First Line	:	631 LEE RD
Second Line	:	APT 1210
City	:	BEDFORD
State	:	OH
Zip	:	44146-3496
Country	:	US
Telephone Number	:	216-450-0598
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	CHARLOTTE D PHILLIPS
Credential	:
Telephone Number	:	216-450-0598

Provider Enumeration Date	:	12/31/2013
Last Update Date	:	12/31/2013

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Directions to “CHARLOTTE PHILLIPS ” Practice Location

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