Provider Demographics
NPI:1023531399
Name:POLLARD, JACQUES (CNA)
Entity type:Individual
Prefix:
First Name:JACQUES
Middle Name:
Last Name:POLLARD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4228 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44144-1713
Mailing Address - Country:US
Mailing Address - Phone:216-849-0180
Mailing Address - Fax:
Practice Address - Street 1:4228 WEST 58 STREET
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44144
Practice Address - Country:US
Practice Address - Phone:216-849-0180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0219474251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0219474Medicaid