MEDICARE: MY HOME TO OUR HOME 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	:	1215670773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY HOME TO OUR HOME LLC

Provider Business Mailing Address
First Line	:	4127 E 142ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1811
Country	:	US
Telephone Number	:	216-379-1517
Fax Number	:

Provider Business Practice Location Address
First Line	:	4127 E 142ND ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-1811
Country	:	US
Telephone Number	:	216-379-1517
Fax Number	:

Authorized Official
Title or Position	:	ADMINNISTRATOR
Name	:	MONICA MARIE MOORE
Credential	:
Telephone Number	:	216-379-1517

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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Directions to “MY HOME TO OUR HOME LLC ” Practice Location

Language	Start Address	Practice Location

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