Provider Demographics
NPI:1417773078
Name:SCOTT, GEORGETTE
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:
Last Name:SCOTT
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 1:17015 PALDA DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-3332
Mailing Address - Country:US
Mailing Address - Phone:216-303-1615
Mailing Address - Fax:330-777-2136
Practice Address - Street 1:17015 PALDA DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-3332
Practice Address - Country:US
Practice Address - Phone:216-303-1615
Practice Address - Fax:330-777-2136
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities