Provider Demographics
NPI:1619310026
Name:PROTEM HOSPICE
Entity Type:Organization
Organization Name:PROTEM HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:ADA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWORIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-663-8188
Mailing Address - Street 1:3535 LEE RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5122
Mailing Address - Country:US
Mailing Address - Phone:216-663-8188
Mailing Address - Fax:216-938-8056
Practice Address - Street 1:3535 LEE RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-5122
Practice Address - Country:US
Practice Address - Phone:216-663-8188
Practice Address - Fax:216-938-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2697890Medicaid
361680Medicare Oscar/Certification