Provider Demographics
NPI:1033404736
Name:INTERIM HEALTHCARE OF CINCINNATI, INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF CINCINNATI, INC
Other - Org Name:INTERIM HEALTHCARE OF NORTHERN KENTUCKY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-436-9404
Mailing Address - Street 1:3005 DIXIE HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2352
Mailing Address - Country:US
Mailing Address - Phone:859-578-9191
Mailing Address - Fax:859-578-9276
Practice Address - Street 1:3005 DIXIE HWY
Practice Address - Street 2:SUITE 130
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2352
Practice Address - Country:US
Practice Address - Phone:859-578-9191
Practice Address - Fax:859-578-9276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-10
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY150136251B00000X, 251F00000X, 251J00000X, 252Y00000X
251E00000X
KY720221251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
No251K00000XAgenciesPublic Health or Welfare
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000002998OtherANTHEM
KY34005595Medicaid
KY7100331180Medicaid
KY41540014Medicaid
KY45342409Medicaid
KY42540039Medicaid
KY42540039Medicaid