Provider Demographics
NPI:1972594711
Name:CLEVELAND HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:CLEVELAND HOME HEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:704-487-5225
Mailing Address - Street 1:105 T R HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3486
Mailing Address - Country:US
Mailing Address - Phone:704-487-5225
Mailing Address - Fax:704-484-4590
Practice Address - Street 1:105 T R HARRIS DR
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3486
Practice Address - Country:US
Practice Address - Phone:704-487-5225
Practice Address - Fax:704-484-4590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0042332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7700418Medicaid
NC0499GOtherHME
NC0614850001Medicare ID - Type UnspecifiedHME