MEDICARE: CARDINAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1023582558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 603912
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-0912
Country	:	US
Telephone Number	:	216-548-1163
Fax Number	:	216-561-2273

Provider Business Practice Location Address
First Line	:	1864 E 89TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-2006
Country	:	US
Telephone Number	:	216-923-6709
Fax Number	:	216-561-2273

Authorized Official
Title or Position	:	CO OWNER
Name	:	MRS. JUAHMEA RIVERS
Credential	:
Telephone Number	:	216-548-1163

Provider Enumeration Date	:	01/17/2019
Last Update Date	:	01/17/2019

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