Healthcare Provider Details

I. General information

NPI: 1144961780
Provider Name (Legal Business Name): A SAFE PLACE AT HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4896 N RANDALL DR
NORTH RANDALL OH
44128-4766
US

IV. Provider business mailing address

4896 N RANDALL DR
NORTH RANDALL OH
44128-4766
US

V. Phone/Fax

Practice location:
  • Phone: 216-688-6406
  • Fax:
Mailing address:
  • Phone: 216-688-6406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LATASHA NICOLE BRADLEY
Title or Position: OWNER
Credential: RN
Phone: 216-688-6406