- Enrollment id
- O20210819001555
- Enrollment state
- OH
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1063089993
- Multiple npi flag
- N
- Ccn
- 361658
- Associate id
- 0648675223
- Organization name
- HEALTH AT HOME HOSPICE - CLEVELAND, LLC
- Doing business as name
- CARETENDERS HOSPICE
- Incorporation date
- 2021-05-26
- Incorporation state
- OH
- Organization type structure
- LLC
- Proprietary nonprofit
- P
- Address line 1
- 6000 LOMBARDO CTR
- Address line 2
- STE 410
- City
- SEVEN HILLS
- State
- OH
- Zip code
- 441316909