MEDICARE: ETHEL AUGUSTUS OWNER

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	:	1104781574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETHEL AUGUSTUS OWNER

Provider Business Mailing Address
First Line	:	4415 EUCLID AVE STE 345
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3758
Country	:	US
Telephone Number	:	216-799-6689
Fax Number	:	216-881-5995

Provider Business Practice Location Address
First Line	:	4415 EUCLID AVE STE 345
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44103-3758
Country	:	US
Telephone Number	:	216-799-6689
Fax Number	:	216-881-5995

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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