Organization
KOMPANION HOMES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONIE D JACKSON (OWNER)
(216) 466-1379
Entity
Organization
Contact information
Practice address
1470 E 173RD ST, CLEVELAND, OH 44110-2931
(216) 466-1379
Mailing address
1470 E 173RD ST, CLEVELAND, OH 44110-2931
(216) 466-1379
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
251S00000X
Community/Behavioral Health Agency
—
—
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2910854
—
OH
Enumeration date
12/07/2022
Last updated
11/04/2024
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