MEDICARE: NURTURING CAREHOME 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	253Z00000X	In Home Supportive Care Agency

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	:	1538304753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURTURING CAREHOME HEALTH AGENCY

Provider Business Mailing Address
First Line	:	19109 NITRA AVE
Second Line	:	MAPLE HEIGHTS
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1609
Country	:	US
Telephone Number	:	216-581-0931
Fax Number	:	216-581-0931

Provider Business Practice Location Address
First Line	:	19109 NITRA AVE
Second Line	:	MAPLE HEIGHTS
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-1609
Country	:	US
Telephone Number	:	216-581-0931
Fax Number	:	216-581-0931

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. BERNICE BONETTA GLENN
Credential	:
Telephone Number	:	216-581-0931

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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