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General NPI Number Information
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NPI Number | 1548825128
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Entity Type | Organization
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Legal Business Name | TOTAL CARE RESIDENTIAL TREATMENT LLC
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Dates
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Enumeration Date | 05/08/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 26361 RED FOX TRL
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City | OAKWOOD VILLAGE
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State | OH
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Zip | 44146-3175
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Country | US
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Telephone | 216-482-9811
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Fax |
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Provider Business Mailing Address
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Address Line | 8535 EVERGREEN TRL APT 206
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City | OLMSTED TWP
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State | OH
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Zip | 44138-8117
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. WESLEY FISHER
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Credential | M.ED
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Telephone | 216-482-9811
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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