Healthcare Provider Details

I. General information

NPI: 1619160900
Provider Name (Legal Business Name): PROVIDENCE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 ALPHA PARK
HIGHLAND HTS OH
44143-2216
US

IV. Provider business mailing address

230 ALPHA PARK
HIGHLAND HTS OH
44143-2216
US

V. Phone/Fax

Practice location:
  • Phone: 440-442-9800
  • Fax:
Mailing address:
  • Phone: 440-442-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: ZHANNA ISKHAKOVA
Title or Position: DON
Credential:
Phone: 440-442-9800