Healthcare Provider Details

I. General information

NPI: 1790555365
Provider Name (Legal Business Name): KEKEE'S HOUSE OF LOVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8613 DENISON AVE UNIT 3
CLEVELAND OH
44102-4923
US

IV. Provider business mailing address

8613 DENISON AVE UNIT 3
CLEVELAND OH
44102-4923
US

V. Phone/Fax

Practice location:
  • Phone: 216-250-6202
  • Fax:
Mailing address:
  • Phone: 216-250-6202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LAKIAH R SAMPSON
Title or Position: CEO
Credential:
Phone: 216-302-4722