Healthcare Provider Details

I. General information

NPI: 1548076532
Provider Name (Legal Business Name): KOALATY HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26101 COUNTRY CLUB BLVD APT 907
NORTH OLMSTED OH
44070-4546
US

IV. Provider business mailing address

26101 COUNTRY CLUB BLVD APT 907
NORTH OLMSTED OH
44070-4546
US

V. Phone/Fax

Practice location:
  • Phone: 440-529-5092
  • Fax:
Mailing address:
  • Phone: 440-529-5092
  • 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: ENJOLI JOHNSON
Title or Position: CEO
Credential: RN
Phone: 440-529-5092