Provider Demographics
NPI:1629733308
Name:SUSTAINING ANGELS HOME CARE, LLC
Entity Type:Organization
Organization Name:SUSTAINING ANGELS HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOFFERION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-383-3125
Mailing Address - Street 1:5815 LANDERBROOK DR UNIT 24768
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-7939
Mailing Address - Country:US
Mailing Address - Phone:800-383-3125
Mailing Address - Fax:
Practice Address - Street 1:7547 MENTOR AVE STE 202
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5432
Practice Address - Country:US
Practice Address - Phone:800-383-3125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)