MEDICARE: EPIC HOME CARE SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1043877038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EPIC HOME CARE SERVICES LLC

Provider Business Mailing Address
First Line	:	1649 CUMBERLAND RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1718
Country	:	US
Telephone Number	:	216-254-5665
Fax Number	:

Provider Business Practice Location Address
First Line	:	1649 CUMBERLAND RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1718
Country	:	US
Telephone Number	:	216-254-5665
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANA GENDRAW
Credential	:
Telephone Number	:	216-254-5665

Provider Enumeration Date	:	05/24/2019
Last Update Date	:	05/24/2019

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