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Organization

TENISHA GLASS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TENISHA GLASS (SOLE)
(216) 551-1822
Entity
Organization

Contact information

Practice address
20371 LORAIN RD APT E5, FAIRVIEW PARK, OH 44126-3455
(216) 551-1822
Mailing address
20371 LORAIN RD APT E5, FAIRVIEW PARK, OH 44126-3455
(216) 551-1822

Taxonomy

Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
400078860202
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3062939
OH
Enumeration date
12/28/2015
Last updated
12/28/2015
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