Basic Information
| Provider Information | |||||||||
| NPI: | 1518699099 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | TARHONDA | ||||||||
| MiddleName: | ROCHELLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | QBHS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9220 MENTOR AVE | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440606412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403549924 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9220 MENTOR AVE | ||||||||
| Address2: | |||||||||
| City: | MENTOR | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440606412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403549924 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2022 | ||||||||
| LastUpdateDate: | 06/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 172V00000X | OH | Y | Other Service Providers | Community Health Worker |
ID Information
| ID | Type | State | Issuer | Description | 0000 | 01 | COMMUNITY | OTHER |