Individual
DWAYNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14001 SCIOTO AVE, EAST CLEVELAND, OH 44112-3738
(216) 421-4427
Mailing address
14001 SCIOTO AVE, EAST CLEVELAND, OH 44112-3738
(216) 421-4427
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
06/21/2024
Last updated
08/20/2024
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