Provider Demographics
NPI:1114105202
Name:VISITING NURSE ASSOCIATION OF CLEVELAND HOSPICE
Entity Type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF CLEVELAND HOSPICE
Other - Org Name:VNA OF CLEVELAND HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISTOSIK
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:216-902-7902
Mailing Address - Street 1:2500 E 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-3204
Mailing Address - Country:US
Mailing Address - Phone:216-902-7902
Mailing Address - Fax:216-694-4162
Practice Address - Street 1:2500 E 22ND STREET
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-3204
Practice Address - Country:US
Practice Address - Phone:216-902-7902
Practice Address - Fax:216-694-4162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OH0035HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
0035HSPOtherOHIO LICENSE #
OH0830140Medicaid
OH361547Medicare UPIN
OH361547Medicare UPIN