Individual
TANYA HAIRSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13417 4TH AVE, EAST CLEVELAND, OH 44112-3113
(440) 210-7833
(440) 210-7833
Mailing address
PO BOX 29025, PARMA, OH 44129-0025
(440) 210-7833
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/11/2022
Last updated
05/11/2022
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