Provider Demographics
NPI:1093067464
Name:CARE AT HOME BY GREEN HILLS LLC
Entity Type:Organization
Organization Name:CARE AT HOME BY GREEN HILLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-465-5065
Mailing Address - Street 1:6557 US HIGHWAY 68 S
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-9536
Mailing Address - Country:US
Mailing Address - Phone:937-465-5065
Mailing Address - Fax:937-465-4390
Practice Address - Street 1:6557 US HIGHWAY 68 S
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357-9536
Practice Address - Country:US
Practice Address - Phone:937-465-5065
Practice Address - Fax:937-465-4390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST LIBERTY CARE CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2134558251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health