Provider Demographics
NPI:1023095528
Name:VNA OF CLEVELAND HOSPICE
Entity type:Organization
Organization Name:VNA OF CLEVELAND HOSPICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LADRIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN EMBA
Authorized Official - Phone:216-931-1320
Mailing Address - Street 1:2500 EAST 22 STREET
Mailing Address - Street 2:VNA OF CLEVELAND HOSPICE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115
Mailing Address - Country:US
Mailing Address - Phone:216-931-1450
Mailing Address - Fax:216-694-6355
Practice Address - Street 1:2500 EAST 22 STREET
Practice Address - Street 2:VNA OF CLEVELAND HOSPICE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115
Practice Address - Country:US
Practice Address - Phone:216-931-1450
Practice Address - Fax:216-694-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0035HSP163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0830140Medicaid
361547Medicare ID - Type Unspecified