MEDICARE: HUMBLY HELPFUL HOMECARE 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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1841780327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUMBLY HELPFUL HOMECARE LLC

Provider Business Mailing Address
First Line	:	481 E 128TH ST # UP
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1833
Country	:	US
Telephone Number	:	216-952-6287
Fax Number	:

Provider Business Practice Location Address
First Line	:	481 E 128TH ST # UP
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1833
Country	:	US
Telephone Number	:	216-952-6287
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIAUNNA R TATE
Credential	:
Telephone Number	:	216-952-6287

Provider Enumeration Date	:	05/10/2018
Last Update Date	:	05/10/2018

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