Healthcare Provider Details

I. General information

NPI: 1164973061
Provider Name (Legal Business Name): HUMANA AT HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 ROCKSIDE RD SUITE 500
INDEPENDENCE OH
44131
US

IV. Provider business mailing address

845 3RD AVE 7TH FLOOR
NEW YORK NY
10022-6601
US

V. Phone/Fax

Practice location:
  • Phone: 440-386-4660
  • Fax:
Mailing address:
  • Phone: 212-994-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DOROTHY BURNS
Title or Position: DIRECTOR, CLINICAL QUALITY
Credential:
Phone: 321-258-7709