Healthcare Provider Details

I. General information

NPI: 1972354645
Provider Name (Legal Business Name): PURPLE HEART HOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5722 CHEVROLET BLVD # B
PARMA OH
44130-1412
US

IV. Provider business mailing address

5722 CHEVROLET BLVD # B
PARMA OH
44130-1412
US

V. Phone/Fax

Practice location:
  • Phone: 216-466-7404
  • Fax: 216-249-9176
Mailing address:
  • Phone: 216-466-7404
  • Fax: 216-249-9176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MUNA BARAILY
Title or Position: CEO
Credential:
Phone: 872-806-3807