Provider Demographics
NPI:1902973605
Name:MID OHIO HOME HEALTH CARE, LLC
Entity type:Organization
Organization Name:MID OHIO HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-751-9780
Mailing Address - Street 1:6422 E MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2358
Mailing Address - Country:US
Mailing Address - Phone:614-751-9780
Mailing Address - Fax:614-751-9782
Practice Address - Street 1:6430 E MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2367
Practice Address - Country:US
Practice Address - Phone:614-751-9780
Practice Address - Fax:614-751-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
368160Medicare ID - Type Unspecified