Healthcare Provider Details

I. General information

NPI: 1518773969
Provider Name (Legal Business Name): BEDROCK HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 BROOKPARK RD STE 10
PARMA OH
44129-6824
US

IV. Provider business mailing address

9701 BROOKPARK RD STE 10
PARMA OH
44129-6824
US

V. Phone/Fax

Practice location:
  • Phone: 216-712-4160
  • Fax: 888-607-9054
Mailing address:
  • Phone: 216-712-4160
  • Fax: 888-607-9054

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: AHMED ISSACK
Title or Position: ADMINISTRATOR
Credential:
Phone: 614-586-5970