Provider Demographics
NPI:1689484941
Name:HOLMES, REGINALD LAMAR JR
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:LAMAR
Last Name:HOLMES
Suffix:JR
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 1:3466 E 145TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4141
Mailing Address - Country:US
Mailing Address - Phone:216-640-3840
Mailing Address - Fax:440-340-5035
Practice Address - Street 1:3966 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-6770
Practice Address - Country:US
Practice Address - Phone:440-340-5086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator