Provider Demographics
NPI:1669094272
Name:NORTHEAST PROFESSIONAL HOME CARE, INC.
Entity type:Organization
Organization Name:NORTHEAST PROFESSIONAL HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:W
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-966-2311
Mailing Address - Street 1:4580 STEPHEN CIR NW STE 301
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:330-966-2381
Practice Address - Street 1:45 CATHEDRAL LN
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1657
Practice Address - Country:US
Practice Address - Phone:330-966-2311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST PROFESSIONAL HOME CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-18
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy