MEDICARE: LIFE HOME HEALTH CARE 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	:	1912228008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	3335 E 55TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1547
Country	:	US
Telephone Number	:	216-812-4689
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 E 55TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1547
Country	:	US
Telephone Number	:	216-812-4689
Fax Number	:	216-812-4690

Authorized Official
Title or Position	:	ADMINISTRATOR/SUPERVISOR
Name	:	MISS JACQUELINE FISHER
Credential	:	REGISTERED NURSE
Telephone Number	:	216-385-3835

Provider Enumeration Date	:	06/13/2010
Last Update Date	:	06/13/2010

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Directions to “LIFE HOME HEALTH CARE LLC ” Practice Location

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