Healthcare Provider Details

I. General information

NPI: 1245143304
Provider Name (Legal Business Name): BURNING RIVER HOME SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 KARL ST
BEREA OH
44017-1380
US

IV. Provider business mailing address

97 KARL ST
BEREA OH
44017-1380
US

V. Phone/Fax

Practice location:
  • Phone: 216-903-6008
  • Fax:
Mailing address:
  • Phone: 216-903-6008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RANDALL SCOTT ABOOD
Title or Position: OWNER
Credential:
Phone: 440-403-5907