Healthcare Provider Details

I. General information

NPI: 1952266116
Provider Name (Legal Business Name): HOMEWATCH CAREGIVERS OF LAKE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9277 CANTERBURY LN
MENTOR OH
44060-6405
US

IV. Provider business mailing address

9277 CANTERBURY LN
MENTOR OH
44060-6405
US

V. Phone/Fax

Practice location:
  • Phone: 810-964-2615
  • Fax:
Mailing address:
  • Phone: 810-964-2615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KENDRA PETERSON
Title or Position: OWNER
Credential:
Phone: 810-964-2615