Provider Demographics
NPI:1952669871
Name:STACHIE CAMPBELL
Entity Type:Organization
Organization Name:STACHIE CAMPBELL
Other - Org Name:SUNSET HOME HEALTH CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:STACHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-630-4645
Mailing Address - Street 1:4796 LITCHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1486
Mailing Address - Country:US
Mailing Address - Phone:216-630-4645
Mailing Address - Fax:216-291-9930
Practice Address - Street 1:4796 LITCHFIELD DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1486
Practice Address - Country:US
Practice Address - Phone:216-630-4645
Practice Address - Fax:216-291-9930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-28
Last Update Date:2012-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0057411Medicaid
OH0057406Medicaid