MEDICARE: MEDSOURCE HOME HEALTH CARE

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		OH

General Provider Information

NPI Number	:	1295921187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSOURCE HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	27801 EUCLID AVE
Second Line	:	560
City	:	EUCLID
State	:	OH
Zip	:	44132-3549
Country	:	US
Telephone Number	:	216-289-9112
Fax Number	:	216-731-8545

Provider Business Practice Location Address
First Line	:	2114 NOBLE RD
Second Line	:
City	:	E CLEVELAND
State	:	OH
Zip	:	44112-1725
Country	:	US
Telephone Number	:	216-289-9112
Fax Number	:	216-289-9114

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERRY L MAYNARD
Credential	:
Telephone Number	:	216-289-9112

Provider Enumeration Date	:	09/24/2007
Last Update Date	:	09/24/2007

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Directions to “MEDSOURCE HOME HEALTH CARE ” Practice Location

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