Provider Demographics
NPI:1558169383
Name:GILCREASE, RODERICKA D
Entity type:Individual
Prefix:
First Name:RODERICKA
Middle Name:D
Last Name:GILCREASE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12813 MATHERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-4671
Mailing Address - Country:US
Mailing Address - Phone:440-523-8979
Mailing Address - Fax:
Practice Address - Street 1:12813 MATHERSON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-4671
Practice Address - Country:US
Practice Address - Phone:440-523-8979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker
No372600000XNursing Service Related ProvidersAdult Companion