Provider Demographics
NPI:1063139616
Name:RIHALY, LUANNA D
Entity type:Individual
Prefix:
First Name:LUANNA
Middle Name:D
Last Name:RIHALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:442 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-1836
Mailing Address - Country:US
Mailing Address - Phone:440-655-8111
Mailing Address - Fax:
Practice Address - Street 1:442 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-1836
Practice Address - Country:US
Practice Address - Phone:440-655-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4303850374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4303850OtherDODD
OH0383929Medicaid