Provider Demographics
NPI:1841635539
Name:M.D. CHOICE HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:M.D. CHOICE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:812-799-1049
Mailing Address - Street 1:5538 25TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3348
Mailing Address - Country:US
Mailing Address - Phone:812-799-1049
Mailing Address - Fax:812-799-1072
Practice Address - Street 1:5538 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3348
Practice Address - Country:US
Practice Address - Phone:812-799-1049
Practice Address - Fax:812-799-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201258130Medicaid
IN201258130AMedicaid
IN201300350AMedicaid
IN201258130AMedicaid