MEDICARE: DOMINEAR HEALTH AGENCY

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	:	1356936264
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINEAR HEALTH AGENCY

Provider Business Mailing Address
First Line	:	3345 E 55TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1547
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3345 E 55TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1547
Country	:	US
Telephone Number	:	216-647-1804
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIELLE MCDONALD
Credential	:
Telephone Number	:	216-647-1804

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/02/2021

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Directions to “DOMINEAR HEALTH AGENCY ” Practice Location

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