Provider Demographics
NPI:1316982986
Name:CLEVELAND HOME CARE, INC.
Entity type:Organization
Organization Name:CLEVELAND HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-368-0951
Mailing Address - Street 1:7354 MAPLELAWN DR
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1883
Mailing Address - Country:US
Mailing Address - Phone:734-368-0951
Mailing Address - Fax:734-485-9818
Practice Address - Street 1:7354 MAPLELAWN DR
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1883
Practice Address - Country:US
Practice Address - Phone:734-368-0951
Practice Address - Fax:734-485-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1344564251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2438713Medicaid
OH368026Medicare ID - Type Unspecified