Provider Demographics
NPI:1366723306
Name:HILL, ERVIN D (STNA)
Entity type:Individual
Prefix:MR
First Name:ERVIN
Middle Name:D
Last Name:HILL
Suffix:
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 ROZELLE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-4141
Mailing Address - Country:US
Mailing Address - Phone:216-470-5807
Mailing Address - Fax:216-268-5386
Practice Address - Street 1:1195 ROZELLE AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-4141
Practice Address - Country:US
Practice Address - Phone:216-470-5807
Practice Address - Fax:216-268-5386
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-05
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401289890811374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH87654321Medicaid