Provider Demographics
NPI:1902182629
Name:NORTHEAST HOME CARE LLC
Entity Type:Organization
Organization Name:NORTHEAST HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JANIKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-688-5454
Mailing Address - Street 1:4466 DARROW RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1866
Mailing Address - Country:US
Mailing Address - Phone:330-688-5454
Mailing Address - Fax:330-688-5737
Practice Address - Street 1:916 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3048
Practice Address - Country:US
Practice Address - Phone:330-920-9921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health