MEDICARE: INDEPENDENT HOME HEALTH INC

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	:	1588846737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDEPENDENT HOME HEALTH INC

Provider Business Mailing Address
First Line	:	6012 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-3205
Country	:	US
Telephone Number	:	440-442-3600
Fax Number	:	440-442-3602

Provider Business Practice Location Address
First Line	:	6012 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-3205
Country	:	US
Telephone Number	:	440-442-3600
Fax Number	:	440-442-3602

Authorized Official
Title or Position	:	CFO
Name	:	LEONID KRUPOVLYANSKIY
Credential	:
Telephone Number	:	718-915-0392

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	03/27/2012

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