Provider Demographics
NPI:1235973793
Name:RICHMOND, JENNIFER (L/COTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RICHMOND
Suffix:
Gender:F
Credentials:L/COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 STANFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-5002
Mailing Address - Country:US
Mailing Address - Phone:216-316-8673
Mailing Address - Fax:
Practice Address - Street 1:9067 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:BROADVIEW HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2512
Practice Address - Country:US
Practice Address - Phone:330-978-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide