Healthcare Provider Details

I. General information

NPI: 1063338135
Provider Name (Legal Business Name): ROBERTA HESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4236 LEAVITT RD
LORAIN OH
44053-2343
US

IV. Provider business mailing address

4236 LEAVITT RD
LORAIN OH
44053-2343
US

V. Phone/Fax

Practice location:
  • Phone: 440-420-9316
  • Fax:
Mailing address:
  • Phone: 440-420-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: