Healthcare Provider Details

I. General information

NPI: 1750640223
Provider Name (Legal Business Name): SIS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15720 LORAIN
CLEVELAND OH
44111
US

IV. Provider business mailing address

15720 LORAIN
CLEVELAND OH
44111
US

V. Phone/Fax

Practice location:
  • Phone: 216-970-6072
  • Fax: 216-452-8382
Mailing address:
  • Phone: 216-979-6072
  • Fax: 216-472-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. GRETCHEN J SILVA
Title or Position: ADMINISTRATOR
Credential:
Phone: 216-970-6072