Provider Demographics
NPI:1427087642
Name:EXECUTIVE CARE LTD
Entity type:Organization
Organization Name:EXECUTIVE CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:740-349-8454
Mailing Address - Street 1:51 N 3RD ST
Mailing Address - Street 2:SUITE 610
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5592
Mailing Address - Country:US
Mailing Address - Phone:740-349-8454
Mailing Address - Fax:740-349-0533
Practice Address - Street 1:51 N 3RD ST
Practice Address - Street 2:SUITE 610
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5592
Practice Address - Country:US
Practice Address - Phone:740-349-8454
Practice Address - Fax:740-349-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2496991Medicaid
OH2496991Medicaid