Provider Demographics
NPI:1881119105
Name:CLEOS HOMECARE AGENCY LLC
Entity type:Organization
Organization Name:CLEOS HOMECARE AGENCY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-221-5051
Mailing Address - Street 1:4037 US HIGHWAY 231 STE B
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-1224
Mailing Address - Country:US
Mailing Address - Phone:334-221-5051
Mailing Address - Fax:
Practice Address - Street 1:4037 US HIGHWAY 231 STE B
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36093-1224
Practice Address - Country:US
Practice Address - Phone:334-221-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17292139251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL=========OtherHOME HEALTH COMPANY
AL=========OtherHOMEHEALTH