Provider Demographics
NPI:1861450009
Name:HOME HEALTH AGENCY- COLUMBUS, LLC
Entity type:Organization
Organization Name:HOME HEALTH AGENCY- COLUMBUS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-476-5160
Mailing Address - Street 1:4770 DUKE DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9376
Mailing Address - Country:US
Mailing Address - Phone:513-492-9167
Mailing Address - Fax:513-492-9213
Practice Address - Street 1:4770 DUKE DR
Practice Address - Street 2:SUITE 170
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9376
Practice Address - Country:US
Practice Address - Phone:513-492-9167
Practice Address - Fax:513-492-9213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH368077Medicare Oscar/Certification