Provider Demographics
NPI:1205605417
Name:EMERALD HOME HEALTHCARE SERVICES
Entity type:Organization
Organization Name:EMERALD HOME HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AYUB
Authorized Official - Middle Name:
Authorized Official - Last Name:IBRAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-806-7880
Mailing Address - Street 1:5425 SOUTHWYCK BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1533
Mailing Address - Country:US
Mailing Address - Phone:419-491-1133
Mailing Address - Fax:419-491-1187
Practice Address - Street 1:5425 SOUTHWYCK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-1533
Practice Address - Country:US
Practice Address - Phone:419-491-1133
Practice Address - Fax:419-491-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-28
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0045466Medicaid