Provider Demographics
NPI:1225149743
Name:PROVIDENCE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:PROVIDENCE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZELENKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-442-1115
Mailing Address - Street 1:301 ALPHA PARK
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2237
Mailing Address - Country:US
Mailing Address - Phone:440-442-1115
Mailing Address - Fax:
Practice Address - Street 1:301 ALPHA PARK
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2237
Practice Address - Country:US
Practice Address - Phone:440-442-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2443109251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2443109Medicaid
OH2443109Medicaid