=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063239960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LA'S DIRECT HOMECARE OF OHIO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2024
-----------------------------------------------------
Last Update Date | 09/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4549 JOYCE AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44128-4920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-772-6782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4549 JOYCE AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44128-4920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-772-6782
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. CYTONIA MARIE WILLIAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-772-6782
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 347E00000X
-----------------------------------------------------
Taxonomy Name | Transportation Broker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------