Provider Demographics
NPI:1912004433
Name:HOME CARE OF LAKE COUNTY
Entity Type:Organization
Organization Name:HOME CARE OF LAKE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOC
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:440-350-2419
Mailing Address - Street 1:7757 AUBURN RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9609
Mailing Address - Country:US
Mailing Address - Phone:440-350-2419
Mailing Address - Fax:440-350-2940
Practice Address - Street 1:7757 AUBURN RD
Practice Address - Street 2:SUITE 7
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9609
Practice Address - Country:US
Practice Address - Phone:440-350-2419
Practice Address - Fax:440-350-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health