Healthcare Provider Details

I. General information

NPI: 1326654740
Provider Name (Legal Business Name): JUSTIN'S LOVE HOME HEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17325 EUCLID AVE STE 2017
CLEVELAND OH
44112-1250
US

IV. Provider business mailing address

26629 MULBERRY CIR
CLEVELAND OH
44143-1048
US

V. Phone/Fax

Practice location:
  • Phone: 216-266-7089
  • Fax:
Mailing address:
  • Phone: 216-266-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LETIA TAYLOR
Title or Position: SOCIAL WORKER
Credential: LSW
Phone: 216-266-7089