MEDICARE: PROMISE ICF AND HOSPICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	251C00000X	Developmentally Disabled Services Day Training Agency
3	251G00000X	Community Based Hospice Care Agency
4	253Z00000X	In Home Supportive Care Agency
5	261QA0600X	Adult Day Care Clinic/Center
6	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center
7	174H00000X	Health Educator

General Provider Information

NPI Number	:	1689533903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMISE ICF AND HOSPICE LLC

Provider Business Mailing Address
First Line	:	3320 BEECHWOOD AVE
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1833
Country	:	US
Telephone Number	:	216-309-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	6412 FLEET AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-7606
Country	:	US
Telephone Number	:	216-309-8111
Fax Number	:	216-309-8111

Authorized Official
Title or Position	:	OWNER
Name	:	LATITIA S HARDAWAY
Credential	:	HARDAQAY
Telephone Number	:	216-309-8111

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	01/21/2026

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