Provider Demographics
NPI:1578151338
Name:AWESOME COMPANIONSHIP CARE AGENCY
Entity Type:Organization
Organization Name:AWESOME COMPANIONSHIP CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-640-2222
Mailing Address - Street 1:3100 E 45TH ST STE 404
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1095
Mailing Address - Country:US
Mailing Address - Phone:216-640-2222
Mailing Address - Fax:216-341-5553
Practice Address - Street 1:3100 E 45TH ST STE 404
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1095
Practice Address - Country:US
Practice Address - Phone:216-640-2222
Practice Address - Fax:216-341-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty