Provider Demographics
NPI:1609105758
Name:WELCOME HOME HEALTHCARE
Entity Type:Organization
Organization Name:WELCOME HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FONDALISA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:216-376-3808
Mailing Address - Street 1:15600 RAMAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-4052
Mailing Address - Country:US
Mailing Address - Phone:216-376-3808
Mailing Address - Fax:
Practice Address - Street 1:15600 RAMAGE AVE
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-4052
Practice Address - Country:US
Practice Address - Phone:216-376-3808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health