Provider Demographics
NPI:1801555032
Name:HOME LIFE HOME HEALTH CARE AGENCY
Entity type:Organization
Organization Name:HOME LIFE HOME HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-394-6842
Mailing Address - Street 1:13613 COATH AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-4631
Mailing Address - Country:US
Mailing Address - Phone:216-394-6842
Mailing Address - Fax:
Practice Address - Street 1:13613 COATH AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-4631
Practice Address - Country:US
Practice Address - Phone:216-394-6842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty