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General NPI Number Information
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NPI Number | 1881119105
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Entity Type | Organization
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Legal Business Name | CLEOS HOMECARE AGENCY LLC
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Dates
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Enumeration Date | 08/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4037 US HIGHWAY 231 STE B
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City | WETUMPKA
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State | AL
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Zip | 36093-1224
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Country | US
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Telephone | 334-221-5051
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Fax |
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Provider Business Mailing Address
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Address Line | 4037 US HIGHWAY 231 STE B
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City | WETUMPKA
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State | AL
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Zip | 36093-1224
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Country | US
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Telephone | 334-221-5051
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Fax |
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Authorized Official
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Title or Position | MANAGER/ OWNER
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Name | SABRINA JACKSON
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Credential |
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Telephone | 334-221-5051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 17292139
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License Number State | AL
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