Provider Demographics
NPI:1598151904
Name:HOMELESS W INCOME
Entity Type:Organization
Organization Name:HOMELESS W INCOME
Other - Org Name:DUST BUSTERS HOMECARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:0WNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRONA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-456-0306
Mailing Address - Street 1:3323 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1691
Mailing Address - Country:US
Mailing Address - Phone:216-456-0306
Mailing Address - Fax:
Practice Address - Street 1:3323 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1691
Practice Address - Country:US
Practice Address - Phone:216-456-0306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH302F00000X302F00000X
OH305R00000X
305R00000X305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization