MEDICARE: ELNORA HOME HEALTH AGENCY, 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	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1831359	OTHER	OH	DODD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174127500
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELNORA HOME HEALTH AGENCY, LLC

Provider Business Mailing Address
First Line	:	5311 NORTHFIELD RD STE 410
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-1135
Country	:	US
Telephone Number	:	216-402-9945
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 NORTHFIELD RD STE 410
Second Line	:
City	:	BEDFORD HEIGHTS
State	:	OH
Zip	:	44146-1135
Country	:	US
Telephone Number	:	216-402-9945
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	REKIAT OLAYIWOLA
Credential	:
Telephone Number	:	216-402-9945

Provider Enumeration Date	:	11/25/2020
Last Update Date	:	11/25/2020

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