Provider Demographics
NPI:1962561373
Name:IN HOME HEALTH, LLC.
Entity type:Organization
Organization Name:IN HOME HEALTH, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-252-5734
Mailing Address - Street 1:1400 ENERGY PARK DR
Mailing Address - Street 2:STE 17
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5248
Mailing Address - Country:US
Mailing Address - Phone:866-506-0469
Mailing Address - Fax:866-226-8634
Practice Address - Street 1:333 N SUMMIT ST
Practice Address - Street 2:16TH FLOOR; LICENSURE & CERTIFICATION
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-2615
Practice Address - Country:US
Practice Address - Phone:419-252-5518
Practice Address - Fax:877-385-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261303-93336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33252300Medicaid
WA6024723Medicaid
TX024618302Medicaid
MN635223500Medicaid
IL341687107001Medicaid
WI33252300Medicaid
0476270016Medicare NSC
WA6024723Medicaid
MN635223500Medicaid