Healthcare Provider Details

I. General information

NPI: 1205204559
Provider Name (Legal Business Name): IDEAL HOMECARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 SNOW RD
PARMA OH
44134-2954
US

IV. Provider business mailing address

3012 SNOW RD
PARMA OH
44134-2954
US

V. Phone/Fax

Practice location:
  • Phone: 216-482-5541
  • Fax:
Mailing address:
  • Phone: 216-482-5541
  • 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 Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MADHAV DHITAL
Title or Position: OWNER
Credential:
Phone: 412-277-6301