Provider Demographics
NPI:1225512460
Name:CARECRUIZ HOMECARE AGENCY LLC
Entity Type:Organization
Organization Name:CARECRUIZ HOMECARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBIAKOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-636-6961
Mailing Address - Street 1:1743 S CENTER STREET EXT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-3361
Mailing Address - Country:US
Mailing Address - Phone:724-536-4172
Mailing Address - Fax:
Practice Address - Street 1:1743 S CENTER STREET EXT
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-3361
Practice Address - Country:US
Practice Address - Phone:724-536-4172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care