Healthcare Provider Details

I. General information

NPI: 1063655975
Provider Name (Legal Business Name): PLATINUM HOME HEALTH CARE SERVICES.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17626 LOMOND BLVD
SHAKER HEIGHTS OH
44120-5241
US

IV. Provider business mailing address

17626 LOMOND BLVD
SHAKER HEIGHTS OH
44120-5241
US

V. Phone/Fax

Practice location:
  • Phone: 216-280-0584
  • Fax: 216-295-0102
Mailing address:
  • Phone: 216-280-0584
  • Fax: 216-295-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number337958
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number337958
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number337958
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number337958
License Number StateOH

VIII. Authorized Official

Name: MRS. LAWANNA ANITA PORTER
Title or Position: CEO
Credential: REGISTERED NURSE
Phone: 216-280-0584