MEDICARE: WYANDOTTE HOME HEALTH CARE COMPANY

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	200425701928	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	OH03887	OTHER	OH	TEMPORARY PROVIDER NUMBER

General Provider Information

NPI Number	:	1861574113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WYANDOTTE HOME HEALTH CARE COMPANY

Provider Business Mailing Address
First Line	:	850 EUCLID AVE STE 619
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3311
Country	:	US
Telephone Number	:	216-583-9002
Fax Number	:	216-583-9003

Provider Business Practice Location Address
First Line	:	850 EUCLID AVE
Second Line	:	SUITE 619
City	:	CLEVELAND
State	:	OH
Zip	:	44114-3306
Country	:	US
Telephone Number	:	216-583-9002
Fax Number	:	216-583-9003

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. EDDIE AMMONS
Credential	:
Telephone Number	:	216-583-9002

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	11/10/2008

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