Healthcare Provider Details

I. General information

NPI: 1073418281
Provider Name (Legal Business Name): CHERITH HOMECARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19305 BURKE ST
SOUTH BEND IN
46637-3902
US

IV. Provider business mailing address

19305 BURKE ST
SOUTH BEND IN
46637-3902
US

V. Phone/Fax

Practice location:
  • Phone: 574-329-0876
  • Fax:
Mailing address:
  • Phone: 574-329-0876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: PRISCAH ODONGO
Title or Position: ADMINSTRATOR/OWNER
Credential:
Phone: 574-329-0876