Provider Demographics
NPI:1699886382
Name:ELUMINA HOME HEALTH, INC
Entity type:Organization
Organization Name:ELUMINA HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-860-0333
Mailing Address - Street 1:1103 SCHROCK RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1179
Mailing Address - Country:US
Mailing Address - Phone:888-860-0333
Mailing Address - Fax:888-645-0333
Practice Address - Street 1:1220 GAY ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3460
Practice Address - Country:US
Practice Address - Phone:740-353-1141
Practice Address - Fax:740-353-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0974058Medicaid
OH0974058Medicaid