=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437571015
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANDS OF LOVE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2014
-----------------------------------------------------
Last Update Date | 01/15/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 707 BROOKPARK RD 302
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44109-5800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-566-4948
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2202 E 70TH ST 4
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44103-4755
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-566-4948
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ADMINISTRATOR
-----------------------------------------------------
Name | MS. DIANNA L BURGESS
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 216-566-4948
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 139142
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------