MEDICARE: WESTCHESTER HOUSE ADULT FAMILY HOME 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	343900000X	Non-emergency Medical Transport (VAN)	180795	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164925566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTCHESTER HOUSE ADULT FAMILY HOME LLC

Provider Business Mailing Address
First Line	:	10305 WESTCHESTER AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3461
Country	:	US
Telephone Number	:	216-772-5450
Fax Number	:	216-649-0665

Provider Business Practice Location Address
First Line	:	10305 WESTCHESTER AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-3461
Country	:	US
Telephone Number	:	216-772-5450
Fax Number	:	216-649-0665

Authorized Official
Title or Position	:	OWNER
Name	:	MS. TERESA LAFAYE WAKEFIELD
Credential	:
Telephone Number	:	216-772-5450

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	06/16/2018

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Directions to “WESTCHESTER HOUSE ADULT FAMILY HOME LLC ” Practice Location

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