Individual
DEQUAN WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
23570 DUFFIELD RD, SHAKER HEIGHTS, OH 44122-3105
(162) 458-4752
Mailing address
PO BOX 22072, BEACHWOOD, OH 44122-0072
(216) 245-8475
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
OH
251E00000X
Home Health Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
347C00000X
Private Vehicle
—
—
3747P1801X
Personal Care Attendant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891509154
—
OH
Enumeration date
04/25/2025
Last updated
04/25/2025
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