Provider Demographics
NPI:1538139910
Name:CLEVELAND HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:CLEVELAND HOME CARE SERVICES LLC
Other - Org Name:FAMILY HOSPICE CLEVELAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTH OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:175 24TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3826
Mailing Address - Country:US
Mailing Address - Phone:423-559-6092
Mailing Address - Fax:423-559-6093
Practice Address - Street 1:175 24TH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3826
Practice Address - Country:US
Practice Address - Phone:423-559-6092
Practice Address - Fax:423-559-6093
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL HEALTHCARE OF CLEVELAND, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-26
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000358251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN044-1505Medicaid
TN4114881OtherBLUE CARE TENNCARE
TN441505Medicare Oscar/Certification