MEDICARE: PROVIDENCE HOME 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	:	1619160900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROVIDENCE HOME CARE

Provider Business Mailing Address
First Line	:	230 ALPHA PARK
Second Line	:
City	:	HIGHLAND HTS
State	:	OH
Zip	:	44143-2216
Country	:	US
Telephone Number	:	440-442-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 ALPHA PARK
Second Line	:
City	:	HIGHLAND HTS
State	:	OH
Zip	:	44143-2216
Country	:	US
Telephone Number	:	440-442-9800
Fax Number	:

Authorized Official
Title or Position	:	DON
Name	:	ZHANNA ISKHAKOVA
Credential	:
Telephone Number	:	440-442-9800

Provider Enumeration Date	:	08/21/2007
Last Update Date	:	08/21/2007

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Directions to “PROVIDENCE HOME CARE ” Practice Location

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