Provider Demographics
NPI:1306467063
Name:VISITING QUEENS HOME CARE SERVICES
Entity type:Organization
Organization Name:VISITING QUEENS HOME CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HILDA
Authorized Official - Middle Name:MUSAMBE
Authorized Official - Last Name:NGOH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:937-248-9683
Mailing Address - Street 1:7818 LAUREL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2581
Mailing Address - Country:US
Mailing Address - Phone:937-248-9683
Mailing Address - Fax:
Practice Address - Street 1:926 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-2806
Practice Address - Country:US
Practice Address - Phone:937-248-9683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7818Medicaid