Provider Demographics
NPI:1083742761
Name:MAPLE LEAF HOME HEALTH CARE
Entity Type:Organization
Organization Name:MAPLE LEAF HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:JERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:614-586-1553
Mailing Address - Street 1:935 S JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1069
Mailing Address - Country:US
Mailing Address - Phone:614-586-1553
Mailing Address - Fax:614-586-1556
Practice Address - Street 1:935 S JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-1069
Practice Address - Country:US
Practice Address - Phone:614-586-1553
Practice Address - Fax:614-586-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2527251Medicaid
OH368076Medicare ID - Type Unspecified