Provider Demographics
NPI:1093000713
Name:MIDOHIOHOMEHEALTHCARE HEALTHCARE
Entity Type:Organization
Organization Name:MIDOHIOHOMEHEALTHCARE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-330-7122
Mailing Address - Street 1:4889 SINCLAIR RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5432
Mailing Address - Country:US
Mailing Address - Phone:614-330-7122
Mailing Address - Fax:614-212-4555
Practice Address - Street 1:4889 SINCLAIR RD
Practice Address - Street 2:SUITE 115
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5432
Practice Address - Country:US
Practice Address - Phone:614-330-7122
Practice Address - Fax:614-212-4555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDOHIOHOMEHEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========5Medicaid