MEDICARE: LAKE OHIO HOME CARE

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	:	1144610551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE OHIO HOME CARE

Provider Business Mailing Address
First Line	:	2490 LEE BLVD STE 318
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1271
Country	:	US
Telephone Number	:	216-744-8687
Fax Number	:

Provider Business Practice Location Address
First Line	:	2490 LEE BLVD STE 318
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-1271
Country	:	US
Telephone Number	:	216-744-8687
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	HEAVEN KANE
Credential	:
Telephone Number	:	216-990-7854

Provider Enumeration Date	:	01/23/2015
Last Update Date	:	01/23/2015

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Directions to “LAKE OHIO HOME CARE ” Practice Location

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