Provider Demographics
NPI:1073605135
Name:COMFORT HEALTHCARE, LLC
Entity Type:Organization
Organization Name:COMFORT HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:VITALIY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KUTSAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-281-9999
Mailing Address - Street 1:8310 DETROIT AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1806
Mailing Address - Country:US
Mailing Address - Phone:216-281-9999
Mailing Address - Fax:216-281-9990
Practice Address - Street 1:8310 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1806
Practice Address - Country:US
Practice Address - Phone:216-281-9999
Practice Address - Fax:216-281-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH03790251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
165671OtherANTHEM BLUE CROSS AND BLUE SHIELD
OH2618804Medicaid
398662OtherWELLCARE OF OHIO, INC.
745457OtherBUCKEYE COMMUNITY HEALTH PLAN
=========OtherCARESOURCE
OH2618804Medicaid