Healthcare Provider Details

I. General information

NPI: 1396558276
Provider Name (Legal Business Name): HOME ROOTS HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6110 MAYFIELD RD UPPR
MAYFIELD HEIGHTS OH
44124-3207
US

IV. Provider business mailing address

5437 MAHONING AVE
YOUNGSTOWN OH
44515-2437
US

V. Phone/Fax

Practice location:
  • Phone: 330-990-0960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SASI KAZA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 330-990-0960