Provider Demographics
NPI:1538924782
Name:LOVE, ELISTINE
Entity type:Individual
Prefix:MR
First Name:ELISTINE
Middle Name:
Last Name:LOVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-1613
Mailing Address - Country:US
Mailing Address - Phone:216-304-8814
Mailing Address - Fax:
Practice Address - Street 1:4415 EUCLID AVE STE 335
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44103-3758
Practice Address - Country:US
Practice Address - Phone:216-400-0207
Practice Address - Fax:440-202-5055
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty