Provider Demographics
NPI:1437919776
Name:DOVE LEGACY HEALTH
Entity type:Organization
Organization Name:DOVE LEGACY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNPC
Authorized Official - Phone:216-262-0155
Mailing Address - Street 1:14108 BECKET RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2825
Mailing Address - Country:US
Mailing Address - Phone:216-262-0155
Mailing Address - Fax:
Practice Address - Street 1:16100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1630
Practice Address - Country:US
Practice Address - Phone:216-200-6988
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty