Healthcare Provider Details

I. General information

NPI: 1417655473
Provider Name (Legal Business Name): INDEPENDENT HEALTHCARE 2.0
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11806 RUTLAND AVE
CLEVELAND OH
44108-1538
US

IV. Provider business mailing address

P.O BOX 654444
CLEVELAND OH
44105
US

V. Phone/Fax

Practice location:
  • Phone: 216-301-6751
  • Fax:
Mailing address:
  • Phone: 216-301-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JETTON R FREEMAN
Title or Position: OWNER
Credential:
Phone: 216-301-6751