Provider Demographics
NPI:1538304753
Name:NURTURING CAREHOME HEALTH AGENCY
Entity Type:Organization
Organization Name:NURTURING CAREHOME HEALTH AGENCY
Other - Org Name:NURTURING CARE HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:BONETTA
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-581-0931
Mailing Address - Street 1:19109 NITRA AVE
Mailing Address - Street 2:MAPLE HEIGHTS
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1609
Mailing Address - Country:US
Mailing Address - Phone:216-581-0931
Mailing Address - Fax:216-581-0931
Practice Address - Street 1:19109 NITRA AVE
Practice Address - Street 2:MAPLE HEIGHTS
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1609
Practice Address - Country:US
Practice Address - Phone:216-581-0931
Practice Address - Fax:216-581-0931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2599282Medicaid