Provider Demographics
NPI:1073959185
Name:PROFOUND HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:PROFOUND HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N.
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:LEAKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-560-9237
Mailing Address - Street 1:5289 EISENHOWER ROAD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229
Mailing Address - Country:US
Mailing Address - Phone:614-560-9237
Mailing Address - Fax:614-433-0064
Practice Address - Street 1:5289 EISENHOWER ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229
Practice Address - Country:US
Practice Address - Phone:614-560-9237
Practice Address - Fax:614-433-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH311778251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2624066Medicaid