Provider Demographics
NPI:1164925566
Name:WESTCHESTER HOUSE ADULT FAMILY HOME LLC
Entity Type:Organization
Organization Name:WESTCHESTER HOUSE ADULT FAMILY HOME LLC
Other - Org Name:WESTCHESTER HOUSE TRANSPORTATION SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LAFAYE
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-772-5450
Mailing Address - Street 1:10305 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3461
Mailing Address - Country:US
Mailing Address - Phone:216-772-5450
Mailing Address - Fax:216-649-0665
Practice Address - Street 1:10305 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3461
Practice Address - Country:US
Practice Address - Phone:216-772-5450
Practice Address - Fax:216-649-0665
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTCHESTER HOUSE ADULT FAMILY HOME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180795343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0065146Medicaid