Healthcare Provider Details

I. General information

NPI: 1770429540
Provider Name (Legal Business Name): PROHEALTH HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19500 LOCHERIE AVE
EUCLID OH
44119-1418
US

IV. Provider business mailing address

19500 LOCHERIE AVE
EUCLID OH
44119-1418
US

V. Phone/Fax

Practice location:
  • Phone: 216-925-6484
  • Fax:
Mailing address:
  • Phone: 216-925-6484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: ANDREA JACKSON
Title or Position: OWNER
Credential: LPN
Phone: 216-925-6484