Healthcare Provider Details

I. General information

NPI: 1265841886
Provider Name (Legal Business Name): SPECIALIZED HOME CARE PROVIDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6006 MARKET ST
BOARDMAN OH
44512-2918
US

IV. Provider business mailing address

6006 MARKET ST
BOARDMAN OH
44512-2918
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-8740
  • Fax: 330-758-8741
Mailing address:
  • Phone: 330-758-8740
  • Fax: 330-758-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JONI AMICONE
Title or Position: AGENCY ADMINISTRATOR
Credential:
Phone: 330-758-8740