Healthcare Provider Details

I. General information

NPI: 1548825128
Provider Name (Legal Business Name): TOTAL CARE RESIDENTIAL TREATMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26361 RED FOX TRL
OAKWOOD VILLAGE OH
44146-3175
US

IV. Provider business mailing address

8535 EVERGREEN TRL APT 206
OLMSTED TWP OH
44138-8117
US

V. Phone/Fax

Practice location:
  • Phone: 216-482-9811
  • 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
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY FISHER
Title or Position: CEO
Credential: M.ED
Phone: 216-482-9811