Provider Demographics
NPI:1366106379
Name:HUMPHRIES, JOAD
Entity type:Individual
Prefix:
First Name:JOAD
Middle Name:
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 EAST 66TH ST
Mailing Address - Street 2:APT 7
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127
Mailing Address - Country:US
Mailing Address - Phone:216-485-2669
Mailing Address - Fax:
Practice Address - Street 1:3100 E 45TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1088
Practice Address - Country:US
Practice Address - Phone:216-485-2669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator