Individual
RANDY JERMAINE SMITH SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7704 HALLE AVE, CLEVELAND, OH 44102-5040
(216) 624-2967
Mailing address
7704 HALLE AVE, CLEVELAND, OH 44102-5040
(216) 624-2967
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
Primary
401054400310
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0365168
—
OH
Enumeration date
12/12/2022
Last updated
12/12/2022
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