Healthcare Provider Details

I. General information

NPI: 1629733308
Provider Name (Legal Business Name): SUSTAINING ANGELS HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7547 MENTOR AVE STE 202
MENTOR OH
44060-5432
US

IV. Provider business mailing address

5815 LANDERBROOK DR UNIT 24768
CLEVELAND OH
44124-7939
US

V. Phone/Fax

Practice location:
  • Phone: 800-383-3125
  • Fax:
Mailing address:
  • Phone: 800-383-3125
  • 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
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: NICOLE JOFFERION
Title or Position: SECRETARY
Credential:
Phone: 800-383-3125