=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477027837
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROFESSIONAL CAREGIVERS OF GREATER CLEVELAND
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2019
-----------------------------------------------------
Last Update Date | 01/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1332 SENECA BLVD
-----------------------------------------------------
City | BROADVIEW HEIGHTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44147-2416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-308-7112
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6090 ROYALTON RD # 353
-----------------------------------------------------
City | NORTH ROYALTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44133-5104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-308-7112
-----------------------------------------------------
Fax | 440-550-8727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGISTERED NURSE
-----------------------------------------------------
Name | JANICE BURNEY
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 440-308-7112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------