Provider Demographics
NPI:1639592710
Name:HATTIE MAE'S HOME CARE AGENCY
Entity Type:Organization
Organization Name:HATTIE MAE'S HOME CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:330-240-5438
Mailing Address - Street 1:2097 MONTCLAIR ST NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-5450
Mailing Address - Country:US
Mailing Address - Phone:330-240-5438
Mailing Address - Fax:330-544-5690
Practice Address - Street 1:2097 MONTCLAIR ST NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5450
Practice Address - Country:US
Practice Address - Phone:330-240-5438
Practice Address - Fax:330-544-5690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH120748251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services