Healthcare Provider Details

I. General information

NPI: 1548939663
Provider Name (Legal Business Name): ELLASTINES HEAVENLY HANDS HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2021
Last Update Date: 09/11/2021
Certification Date: 09/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 24TH ST NE
CANTON OH
44714-1944
US

IV. Provider business mailing address

1326 24TH ST NE
CANTON OH
44714-1944
US

V. Phone/Fax

Practice location:
  • Phone: 234-281-5451
  • Fax:
Mailing address:
  • Phone: 234-281-5451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHERRY WEBSTER
Title or Position: FOUNDER
Credential:
Phone: 234-281-5451