Provider Demographics
NPI:1538178041
Name:OTTERBEIN HOME HEALTH, LLC
Entity type:Organization
Organization Name:OTTERBEIN HOME HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:513-933-5418
Mailing Address - Street 1:3855 LOWER MARKET ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7654
Mailing Address - Country:US
Mailing Address - Phone:513-933-5401
Mailing Address - Fax:513-932-1054
Practice Address - Street 1:570 N STATE ROUTE 741 # 222
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8839
Practice Address - Country:US
Practice Address - Phone:513-696-8565
Practice Address - Fax:513-696-8563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03828251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH03828OtherSTATE AGENCY ID NUMBER
OH2641645Medicaid
OH2641645Medicaid
OH368118Medicare ID - Type UnspecifiedPROVIDER