=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447391438
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRATERNAL HEALTH CARE LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2007
-----------------------------------------------------
Last Update Date | 10/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1601 W 117TH ST
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44107-5254
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-251-2559
-----------------------------------------------------
Fax | 216-251-2580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1601 W 117TH ST
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44107-5226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-251-2559
-----------------------------------------------------
Fax | 216-251-2580
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. MERCEDES PEREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-251-2559
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------