Individual
MR. CHARLIE PERNELL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
STNA
Contact information
Practice address
1101 ADDISON RD, CLEVELAND, OH 44103-1535
(216) 254-1938
Mailing address
1101 ADDISON RD, CLEVELAND, OH 44103-1535
(216) 254-1938
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
501039291105
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
501039291105
STNA
OH
Enumeration date
07/18/2013
Last updated
07/18/2013
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