Provider Demographics
NPI:1033711049
Name:AGE LINE HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:AGE LINE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:CHINEMEREM
Authorized Official - Last Name:OKOROAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-672-8981
Mailing Address - Street 1:4350 ROCKY RIVER DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-2504
Mailing Address - Country:US
Mailing Address - Phone:216-672-8981
Mailing Address - Fax:216-941-6127
Practice Address - Street 1:4350 ROCKY RIVER DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-2504
Practice Address - Country:US
Practice Address - Phone:216-672-8981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2922672Medicaid