MEDICARE: FRATERNAL 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1447391438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRATERNAL HEALTH CARE LLC.

Provider Business Mailing Address
First Line	:	1601 W 117TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44107-5226
Country	:	US
Telephone Number	:	216-251-2559
Fax Number	:	216-251-2580

Provider Business Practice Location Address
First Line	:	1601 W 117TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44107-5254
Country	:	US
Telephone Number	:	216-251-2559
Fax Number	:	216-251-2580

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MERCEDES PEREZ
Credential	:
Telephone Number	:	216-251-2559

Provider Enumeration Date	:	02/11/2007
Last Update Date	:	10/17/2012

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