=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205645157
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHERISHED PATH HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2025
-----------------------------------------------------
Last Update Date | 01/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4336 STRAIGHT ARROW RD
-----------------------------------------------------
City | BEAVERCREEK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45430-1690
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-435-9135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 850 EUCLID AVE STE 819
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44114-3315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | BELLE IRADUKUNDA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-435-9135
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------