NPIMap

Organization Active NPI

Northeast Professional Home Care, Inc.

  • Home Health Agency
  • Canton, OH
National Provider Identifier
1184615148
Registry record updated Aug 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
NORTHEAST PROFESSIONAL HOME CARE, INC.
Practice address
4580 Stephen Cir NW Ste 301
Canton, OH 44718-3646
Phone
(330) 966-2311
Fax
(330) 966-2381
NPI assigned
Oct 31, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dale W Wells
Title
Ceo
Phone
(330) 966-2311

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary
Physical Therapy Clinic/Center 261QP2000X

Addresses

Primary practice location

4580 Stephen Cir NW Ste 301
Canton, OH 44718-3646

Mailing address

4580 Stephen Cir NW Ste 301
Canton, OH 44718-3646
Phone (330) 966-2311

Other names 2

  • Northeast Professional Home Care Doing business as
  • Northeast Professional Home Care Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120404000817 OH Part A Provider - Home Health Agency 6901066679 Practice locations: Canton, OH

Home health agency certification: CCN 367696

Legal name
NORTHEAST PROFESSIONAL HOME CARE, INC.
Doing business as
NORTHEAST PROFESSIONAL HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 12, 1996
Last certification
Aug 9, 2018
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Apr 20, 1995 in OH
Enrollment address
4580 Stephens Cir NW
Ste 301
Canton, OH 44718-3646

Care Compare: Home health agency

Medicare Care Compare
Listed as
Northeast Professional Home CareCCN 367696
Overall star rating
5 of 5
Ownership
Proprietary
Certified
Sep 12, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0927833Northeast Professional4580 Stephens Cir NW, #301, Canton, OH 44718Certificate of waiverApr 29, 2027

National Provider Directory

National Provider Directory
Tax ID family
Northeast Professional Home Care Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4580 Stephens Cir NW
Ste 301
Canton, OH 44718
Phone (330) 966-2311

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kristen L Lattimer Individual W-2 Managing EmployeeExecutive Director Oct 29, 2018
Operational/Managerial ControlExecutive Director Oct 29, 2018
Anthony Vallone Individual Corporate Officer May 1, 1995
Corporate Director May 1, 1995
W-2 Managing Employee May 1, 1995
Operational/Managerial Control May 1, 1995
Eunsook Vallone Individual 5% Or Greater Direct Ownership InterestOwner May 15, 1995 100%
Corporate Officer May 15, 1995
Corporate Director May 15, 1995
W-2 Managing Employee May 15, 1995
Operational/Managerial Control May 15, 1995

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 8

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1184615148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4580 STEPHEN CIR NW STE 301",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183646",
            "telephone_number": "330-966-2311",
            "fax_number": "330-966-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4580 STEPHEN CIR NW STE 301",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447183646",
            "telephone_number": "330-966-2311",
            "fax_number": "330-966-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST PROFESSIONAL HOME CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-31",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "WELLS",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "330-966-2311"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northeast Professional Home Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northeast Professional Home Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Northeast Professional Home Care Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canton, OH

Sources for this page

Verify at the official NPI Registry.