Provider Demographics
NPI:1083803670
Name:HOME DELIVERY HEALTHCARE, L.L.C.
Entity Type:Organization
Organization Name:HOME DELIVERY HEALTHCARE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNHA, RD/LD
Authorized Official - Phone:330-420-0325
Mailing Address - Street 1:840 N MARKET ST
Mailing Address - Street 2:P.O. BOX 487
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-1022
Mailing Address - Country:US
Mailing Address - Phone:330-420-0325
Mailing Address - Fax:330-420-9821
Practice Address - Street 1:840 N MARKET ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1022
Practice Address - Country:US
Practice Address - Phone:330-420-0325
Practice Address - Fax:330-420-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
137567153OtherOH DEPT. OF AGING
OH2964770Medicaid
137567153OtherOH DEPT. OF AGING