Provider Demographics
NPI:1265841886
Name:SPECIALIZED HOME CARE PROVIDERS, LLC
Entity Type:Organization
Organization Name:SPECIALIZED HOME CARE PROVIDERS, LLC
Other - Org Name:SPECIALIZED SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AGENCY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMICONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-758-8740
Mailing Address - Street 1:6006 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2918
Mailing Address - Country:US
Mailing Address - Phone:330-758-8740
Mailing Address - Fax:330-758-8741
Practice Address - Street 1:6006 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2918
Practice Address - Country:US
Practice Address - Phone:330-758-8740
Practice Address - Fax:330-758-8741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care