Healthcare Provider Details

I. General information

NPI: 1093472623
Provider Name (Legal Business Name): LEILA HIGGINBOTHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 E 41ST ST
LORAIN OH
44055-2612
US

IV. Provider business mailing address

1936 E 41ST ST
LORAIN OH
44055-2612
US

V. Phone/Fax

Practice location:
  • Phone: 440-225-4400
  • Fax:
Mailing address:
  • Phone: 440-225-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number601413470521
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number601413470521
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: