Individual
CHARISSE LILLIAN ALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1440 W PROSPECT RD, ASHTABULA, OH 44004-6668
(440) 319-2078
(440) 998-5820
Mailing address
PO BOX 548, ASHTABULA, OH 44005-0548
(440) 319-2078
(440) 998-5820
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/16/2020
Last updated
12/16/2020
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