Individual provider · NPI-1

Angel Tennille Alexander

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities · Cleveland, OH

NPI number1649000118
StatusActive
Last updated in NPPESAug 7, 2024

Details

NPI
1649000118
Entity type
Individual (NPI-1)
Name
Angel Tennille Alexander
Sex
Female
Sole proprietor
Yes
Enumeration date
Aug 7, 2024
Certification date
Aug 7, 2024
Last updated
Aug 7, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities––Yes

Practice location

11216 Parkview Ave
Cleveland, OH 44104-5058

Phone 216-727-6067

Mailing address

11216 Parkview Ave
Cleveland, OH 44104-5058

Phone 216-727-6067

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