Provider Demographics
NPI:1417904103
Name:INDEPENDANT HOME HEALTH CARE NON-AIDE
Entity Type:Organization
Organization Name:INDEPENDANT HOME HEALTH CARE NON-AIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH CARE PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CLEAVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-922-3330
Mailing Address - Street 1:645 W BATH RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3002
Mailing Address - Country:US
Mailing Address - Phone:330-922-3330
Mailing Address - Fax:330-922-3330
Practice Address - Street 1:3406 PRANGE DR
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3224
Practice Address - Country:US
Practice Address - Phone:330-945-6304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2225612320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH109005954201Medicaid
OH103293964599Medicaid