Provider Demographics
NPI:1659134617
Name:WAYMAKER HOMECARE LLC
Entity Type:Organization
Organization Name:WAYMAKER HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEBERLIZA
Authorized Official - Middle Name:S
Authorized Official - Last Name:STALCUP
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-212-5554
Mailing Address - Street 1:P.O. BOX 900
Mailing Address - Street 2:
Mailing Address - City:GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:44232-1583
Mailing Address - Country:US
Mailing Address - Phone:330-417-3027
Mailing Address - Fax:
Practice Address - Street 1:5458 FULTON RD, CANTON OHIO 44718
Practice Address - Street 2:SUITE B
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718
Practice Address - Country:US
Practice Address - Phone:330-465-4987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health