Provider Demographics
NPI:1447846811
Name:MURRAY-DAVIS, RONELL
Entity type:Individual
Prefix:
First Name:RONELL
Middle Name:
Last Name:MURRAY-DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2117
Mailing Address - Country:US
Mailing Address - Phone:216-385-1648
Mailing Address - Fax:
Practice Address - Street 1:115 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-2117
Practice Address - Country:US
Practice Address - Phone:216-385-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0235265Medicaid