Most Relevant Information
Provider Data
| NPI Number: | 1003523200 |
| Provider Name: | BRENDA BERRY SAMPLE |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/28/2022 |
| Last Updated: | 10/28/2022 |
Provider Practice Location
7232 JUSTIN WAY
MENTOR
OH
440604881
Practice Location Phone/Fax
| Phone: | 4405788200 |
| Fax: |
Provider Mailing Location
7232 JUSTIN WAY
MENTOR
OH
440604881
Provider Mailing Phone/Fax
| Phone: | 4405788200 |
| Fax: |