Provider Demographics
NPI:1043413305
Name:JEWISH COMMUNITY CARE AT HOME CORP.
Entity Type:Organization
Organization Name:JEWISH COMMUNITY CARE AT HOME CORP.
Other - Org Name:COMMUNITY CARE AT HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:TINDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-504-6476
Mailing Address - Street 1:29125 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4622
Mailing Address - Country:US
Mailing Address - Phone:216-504-6476
Mailing Address - Fax:216-916-9126
Practice Address - Street 1:29125 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44122-4622
Practice Address - Country:US
Practice Address - Phone:216-378-8660
Practice Address - Fax:216-916-9126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH367770251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2164036Medicaid