Provider Demographics
NPI:1043074297
Name:MESA HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:MESA HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:FADUMO
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-707-3555
Mailing Address - Street 1:733 E DUBLIN GRANVILLE RD STE 20
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3200
Mailing Address - Country:US
Mailing Address - Phone:619-707-3555
Mailing Address - Fax:
Practice Address - Street 1:733 E DUBLIN GRANVILLE RD STE 20
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3200
Practice Address - Country:US
Practice Address - Phone:619-707-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health