MEDICARE: MEADOWBROOK SERVICES, 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

General Provider Information

NPI Number	:	1447866280
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEADOWBROOK SERVICES, LLC

Provider Business Mailing Address
First Line	:	1789 OLD FORGE RD
Second Line	:
City	:	MOGADORE
State	:	OH
Zip	:	44260-9704
Country	:	US
Telephone Number	:	330-803-4969
Fax Number	:

Provider Business Practice Location Address
First Line	:	2780 S ARLINGTON RD STE 201
Second Line	:
City	:	COVENTRY TOWNSHIP
State	:	OH
Zip	:	44312-4707
Country	:	US
Telephone Number	:	330-803-4969
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DANIEL UNSWORTH
Credential	:	C-WIP, CESP
Telephone Number	:	330-803-4969

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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