Provider Demographics
NPI:1144610551
Name:LAKE OHIO HOME CARE
Entity Type:Organization
Organization Name:LAKE OHIO HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEAVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-990-7854
Mailing Address - Street 1:2490 LEE BLVD STE 318
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1271
Mailing Address - Country:US
Mailing Address - Phone:216-744-8687
Mailing Address - Fax:
Practice Address - Street 1:2490 LEE BLVD STE 318
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1271
Practice Address - Country:US
Practice Address - Phone:216-744-8687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health