Provider Demographics
NPI:1407556350
Name:CUSTODIAN HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:CUSTODIAN HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:FATHIAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SULE KAZEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-423-9048
Mailing Address - Street 1:6335 WINTER FOE TRL
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4369
Mailing Address - Country:US
Mailing Address - Phone:216-971-0448
Mailing Address - Fax:
Practice Address - Street 1:6335 WINTER FOE TRL
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4369
Practice Address - Country:US
Practice Address - Phone:216-971-0448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health