Provider Demographics
NPI:1609671833
Name:BAILEY, RODRIQUEZ JR
Entity type:Individual
Prefix:
First Name:RODRIQUEZ
Middle Name:
Last Name:BAILEY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 SHAKESPEARE DR
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-1132
Mailing Address - Country:US
Mailing Address - Phone:216-536-8351
Mailing Address - Fax:
Practice Address - Street 1:6150 PARK SQUARE DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4153
Practice Address - Country:US
Practice Address - Phone:440-384-8601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator