MEDICARE: CLEVELAND HOME HEALTH AGENCY

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	332B00000X	Durable Medical Equipment & Medical Supplies	HC0042	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0499G	OTHER	NC	HME

General Provider Information

NPI Number	:	1972594711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND HOME HEALTH AGENCY

Provider Business Mailing Address
First Line	:	105 T R HARRIS DR
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-3486
Country	:	US
Telephone Number	:	704-487-5225
Fax Number	:	704-484-4590

Provider Business Practice Location Address
First Line	:	105 T R HARRIS DR
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-3486
Country	:	US
Telephone Number	:	704-487-5225
Fax Number	:	704-484-4590

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	PETE MOORE
Credential	:	CEO
Telephone Number	:	704-487-5225

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	08/22/2020

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Directions to “CLEVELAND HOME HEALTH AGENCY ” Practice Location

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