Provider Demographics
NPI:1063548618
Name:TRI STATE HOME HEALTH, LLC
Entity type:Organization
Organization Name:TRI STATE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:DICKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:330-278-2781
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:HINCKLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44233-0308
Mailing Address - Country:US
Mailing Address - Phone:330-278-2781
Mailing Address - Fax:330-278-2711
Practice Address - Street 1:990 MCKEE TRL
Practice Address - Street 2:
Practice Address - City:HINCKLEY
Practice Address - State:OH
Practice Address - Zip Code:44233-9406
Practice Address - Country:US
Practice Address - Phone:330-278-2781
Practice Address - Fax:330-278-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health