MEDICARE: GIFTED HANDS HEALTHCARE ACADEMY 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	251E00000X	Home Health Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1861005076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTED HANDS HEALTHCARE ACADEMY LLC

Provider Business Mailing Address
First Line	:	732 QUILLIAMS RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44121-1956
Country	:	US
Telephone Number	:	216-260-3444
Fax Number	:

Provider Business Practice Location Address
First Line	:	17325 EUCLID AVE STE 3022
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44112-1255
Country	:	US
Telephone Number	:	216-260-3444
Fax Number	:

Authorized Official
Title or Position	:	RN/OWNER/INSTRUCTOR
Name	:	TARA RANITA EDWARDS-COLEMAN
Credential	:	RN
Telephone Number	:	216-260-3444

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	12/02/2020

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