MEDICARE: PURITY HOME HEALTH CARE 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	261QD1600X	Developmental Disabilities Clinic/Center
2	385H00000X	Respite Care

General Provider Information

NPI Number	:	1124898630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURITY HOME HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	17325 EUCLID AVE STE 4104
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1262
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17325 EUCLID AVE STE 4104
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1262
Country	:	US
Telephone Number	:	330-368-2617
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ASHLEE MITCHELL
Credential	:
Telephone Number	:	440-832-1983

Provider Enumeration Date	:	01/05/2024
Last Update Date	:	01/05/2024

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