Provider Demographics
NPI:1932932951
Name:PHILLIPS, EBONY D
Entity type:Individual
Prefix:
First Name:EBONY
Middle Name:D
Last Name:PHILLIPS
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 1:24900 ROCKSIDE RD APT 347
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1993
Mailing Address - Country:US
Mailing Address - Phone:216-303-1096
Mailing Address - Fax:
Practice Address - Street 1:24900 ROCKSIDE RD APT 347
Practice Address - Street 2:
Practice Address - City:BEDFORD HTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1993
Practice Address - Country:US
Practice Address - Phone:216-303-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant