Provider Demographics
NPI:1083832612
Name:COMMUNITY MERCY HOME CARE SERVICES OF SPRINGFIELD, LLC
Entity Type:Organization
Organization Name:COMMUNITY MERCY HOME CARE SERVICES OF SPRINGFIELD, LLC
Other - Org Name:COMMUNITY MERCY HOMECARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, FINANACE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-576-8478
Mailing Address - Street 1:6281 TRI RIDGE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8345
Mailing Address - Country:US
Mailing Address - Phone:513-576-8472
Mailing Address - Fax:
Practice Address - Street 1:9963 CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3823
Practice Address - Country:US
Practice Address - Phone:513-942-3095
Practice Address - Fax:513-942-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-1252950251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2287985Medicaid
OH2287985Medicaid