Provider Demographics
NPI:1124850540
Name:CLEVELAND, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:CLEVELAND
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 1:12140 VILLAGE WOODS DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-6067
Mailing Address - Country:US
Mailing Address - Phone:513-226-5803
Mailing Address - Fax:
Practice Address - Street 1:12140 VILLAGE WOODS DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-6067
Practice Address - Country:US
Practice Address - Phone:513-226-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion