Provider Demographics
NPI:1114105202
Name:VISITING NURSE ASSOCIATION OF CLEVELAND HOSPICE
Entity type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF CLEVELAND HOSPICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:216-931-1391
Mailing Address - Street 1:925 KEYNOTE CIR STE 300
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-1869
Mailing Address - Country:US
Mailing Address - Phone:216-931-1391
Mailing Address - Fax:216-694-4162
Practice Address - Street 1:925 KEYNOTE CIR STE 300
Practice Address - Street 2:
Practice Address - City:BROOKLYN HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44131-1869
Practice Address - Country:US
Practice Address - Phone:216-931-1391
Practice Address - Fax:216-694-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251G00000X
OH0035HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0830140Medicaid
0035HSPOtherOHIO LICENSE #
OH361547Medicare UPIN
OH361547Medicare UPIN