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General NPI Number Information
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NPI Number | 1043909310
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Entity Type | Organization
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Legal Business Name | HAVEN OF HOPE ADULT FAMILY HOME LLC
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 428 E 123RD ST
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City | CLEVELAND
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State | OH
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Zip | 44108-1704
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Country | US
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Telephone | 216-926-9243
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Fax |
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Provider Business Mailing Address
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Address Line | 3474 TULLAMORE RD
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City | CLEVELAND HEIGHTS
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State | OH
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Zip | 44118-3019
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Country | US
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Telephone | 216-926-9243
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. RANDALENE NICHOLE PORCH
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Credential |
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Telephone | 216-926-9243
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number |
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License Number State |
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