HOSPICE OF THE WESTERN RESERVE INC (NPI# 1811163009) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811163009 |
| Entity Type | Organization |
| Organization Name | HOSPICE OF THE WESTERN RESERVE INC |
| Practice Address |
17876 Saint Clair Ave Cleveland OH 44110-2602 |
| Practice Telephone | 2163832222 |
| Practice Fax Number | 2162980400 |
| Mailing Telephone | 2163832222 |
| Mailing Fax Number | 2162980400 |
| Enumeration Date | 2008-05-07 |
| Last Update Date | 2017-05-02 |
| Authorized Official Name | MR. WILLIAM E. FINN (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 2163832222 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 364S00000X | Clinical Nurse Specialist | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | MEDICARE PTAN | 9321651 | 01 |
| OH | 2619698 | 05 |
| Street Address |
17876 SAINT CLAIR AVE |
| City | CLEVELAND |
| State | OH |
| Zip Code | 44110-2602 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942206388 | Paul F Hergenroeder | Internal Medicine | 17876 Saint Clair Ave, Cleveland, OH 44110 | 2005-06-21 |
| 1568075935 | Miranda Louise Raggets | Nurse Practitioner | 17876 Saint Clair Ave, Cleveland, OH 44110-2602 | 2020-08-26 |
| 1578111696 | Amanda Dawn Bovee | Nurse Practitioner | 17876 Saint Clair Ave, Cleveland, OH 44110 | 2019-09-02 |
| 1821646589 | Jennah Hassel | Nurse Practitioner | 17876 Saint Clair Ave, Cleveland, OH 44110-2602 | 2019-08-27 |
| 1285295980 | Cynthia Lynn Boggins | Nurse Practitioner | 17876 Saint Clair Ave, Cleveland, OH 44110-2602 | 2019-06-24 |
| 1477033918 | Susan Lacey Antonelli | Nurse Practitioner | 17876 Saint Clair Ave, Cleveland, OH 44110-2602 | 2018-08-15 |
| 1386120905 | Eric F Kennedy | Licensed Practical Nurse | 17876 Saint Clair Ave, Cleveland, OH 44110-2602 | 2018-07-17 |
| 1689150773 | Nicole Marie Sugalski | Nurse Practitioner | 17876 Saint Clair Ave, Cleveland, OH 44110 | 2018-07-12 |
| 1487157806 | Erin Welo | Nurse Practitioner | 17876 Saint Clair Ave, Cleveland, OH 44110-2602 | 2018-03-12 |
| 1336672104 | Micaela Pap | Nurse Practitioner | 17876 Saint Clair Ave, Cleveland, OH 44110-2602 | 2017-04-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265952287 | Tamika Bonner-conway | Licensed Practical Nurse | 15315 Lucknow Ave, Cleveland, OH 44110 | 2017-06-21 |
| 1831554039 | Neecy's Transportation LLC | Non-emergency Medical Transport (VAN) | 14036 St.clair Ave, Cleveland, OH 44110 | 2015-12-15 |
| 1770970758 | Sherri Craig | Home Health Aide | 16201b Lakeshore Blvd Apt123, Cleveland, OH 44110 | 2015-04-17 |
| 1538576897 | Alayjah M Terrell | Home Health Aide | 917 East 150th, Cleveland, OH 44110 | 2014-07-18 |
| 1700204955 | East Academy, Inc. | Local Education Agency (LEA) | 17520 Kipling, Cleveland, OH 44110 | 2014-04-04 |
| 1578990867 | Delaundria Denise Benjamin | Licensed Practical Nurse | 14206 Westropp Ave, Apt. 211, Cleveland, OH 44110 | 2013-10-01 |
| 1114262789 | Epiphany Damaja Baker | Home Health Aide | 892 E. 139th Street, Cleveland, OH 44110 | 2012-12-07 |
| 1174872543 | Sarah Ann Blowers | Nurse Practitioner | 17876 St. Clair Avenue, Cleveland, OH 44110 | 2012-08-31 |
| 1447495312 | Kathy Jean Taylor | Non-emergency Medical Transport (VAN) | 15218 Lakeshore Blvd, Cleveland, OH 44110 | 2008-12-08 |
| 1689832420 | Glenda Alise Johnson | Nursing Home Administrator | 13514 Kelso Ave, Cleveland, OH 44110 | 2008-05-29 |
| Find all providers in zip 44110 | ||||
| Taxonomy Code | 364S00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses and clinical experience, is expert in a specialty area of nursing practice within one or more of the components of direct patient/client care, consultation, education, research and administration. |
| Notes: Sources: American Nurses Association, American Nurses Credentialing Center, 1996 Certification Catalogue and The Interagency Conference on Nursing Statistics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801410030 | Julie Simon | Clinical Nurse Specialist | 9500 Euclid Ave # P3-112, Cleveland, OH 44195-0001 | 2020-06-03 |
| 1548234958 | Gwenn Holler | Clinical Nurse Specialist | 18101 Lorain Avenue, Cleveland, OH 44111 | 2006-02-14 |
| 1407473887 | Heather Keibler | Clinical Nurse Specialist | 2500 Metrohealth Dr, Cleveland, OH 44109-1900 | 2020-07-01 |
| 1639793151 | Marian Soat | Clinical Nurse Specialist | 9500 Euclid Ave, Cleveland, OH 44195-0001 | 2020-06-01 |
| 1407412117 | Lauren Ann Bruwer | Clinical Nurse Specialist | 9500 Euclid Ave, Cleveland, OH 44195-0001 | 2019-05-17 |
| 1376000315 | Carol Giomuso | Clinical Nurse Specialist | 10701 East Blvd, Cleveland, OH 44106-1702 | 2019-02-26 |
| 1013444116 | Maya Shamailov | Clinical Nurse Specialist | 9500 Euclid Ave, Cleveland, OH 44195-0001 | 2017-05-19 |
| 1184179590 | Jeanette Kubicki | Clinical Nurse Specialist | 9500 Euclid Ave, Mail Code: Qb1, Cleveland, OH 44195-0001 | 2016-08-16 |
| 1508319351 | James M Ward | Clinical Nurse Specialist | 4400 Euclid Ave, Cleveland, OH 44103-3734 | 2016-07-28 |
| 1700236429 | Kimberly Kalo | Clinical Nurse Specialist | 9500 Euclid Ave, Mail Code Hsb 111, Cleveland, OH 44195-0001 | 2016-06-14 |
| Find all providers in CLEVELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.