MEDICARE: KIMBERLY MONIQUE HATCHER HOME CARE 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	376K00000X	Nurse's Aide		OH
2	376K00000X	Nurse's Aide	379371621100	OH

General Provider Information

NPI Number	:	1760947360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MONIQUE HATCHER HOME CARE AGENCY

Provider Business Mailing Address
First Line	:	14302 CEDAR RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-3316
Country	:	US
Telephone Number	:	216-471-7219
Fax Number	:

Provider Business Practice Location Address
First Line	:	14302 CEDAR RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-3316
Country	:	US
Telephone Number	:	216-471-7219
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2019
Last Update Date	:	02/07/2019

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Directions to “ KIMBERLY MONIQUE HATCHER HOME CARE AGENCY” Practice Location

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