Provider Demographics
NPI:1477637163
Name:PROTEM HOMECARE
Entity Type:Organization
Organization Name:PROTEM HOMECARE
Other - Org Name:LIGHTHOUSE HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-644-6084
Mailing Address - Street 1:5455 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-7812
Mailing Address - Country:US
Mailing Address - Phone:216-377-1927
Mailing Address - Fax:216-377-1974
Practice Address - Street 1:5455 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-7812
Practice Address - Country:US
Practice Address - Phone:216-377-1927
Practice Address - Fax:216-377-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2697890Medicaid
OH368150Medicare Oscar/Certification