Provider Demographics
NPI:1093071664
Name:NIA HOMECARE LLC
Entity Type:Organization
Organization Name:NIA HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-220-8881
Mailing Address - Street 1:16004 BROADWAY AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-2575
Mailing Address - Country:US
Mailing Address - Phone:216-220-8881
Mailing Address - Fax:216-220-8882
Practice Address - Street 1:16004 BROADWAY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-2575
Practice Address - Country:US
Practice Address - Phone:216-220-8881
Practice Address - Fax:216-220-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-07
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health