Provider Demographics
NPI:1972594802
Name:NORTHEAST PROFESSIONAL HOME, INC.
Entity Type:Organization
Organization Name:NORTHEAST PROFESSIONAL HOME, INC.
Other - Org Name:NORTHEAST PROFESSIONAL CAREGIVERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:W
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CHCE
Authorized Official - Phone:330-966-2311
Mailing Address - Street 1:4580 STEPHEN CIR NW STE 302
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3646
Mailing Address - Country:US
Mailing Address - Phone:330-966-2311
Mailing Address - Fax:330-966-6893
Practice Address - Street 1:4580 STEPHEN CIR NW STE 302
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3646
Practice Address - Country:US
Practice Address - Phone:330-966-2311
Practice Address - Fax:330-966-6893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health