Provider Demographics
NPI:1093995664
Name:OHIO HOME CARE PROGRAM
Entity Type:Organization
Organization Name:OHIO HOME CARE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:WALLRT
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:740-858-2828
Mailing Address - Street 1:613 JETT ST
Mailing Address - Street 2:
Mailing Address - City:WEST PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45663-6213
Mailing Address - Country:US
Mailing Address - Phone:740-858-2828
Mailing Address - Fax:
Practice Address - Street 1:613 JETT ST
Practice Address - Street 2:
Practice Address - City:WEST PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45663-6213
Practice Address - Country:US
Practice Address - Phone:740-858-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 113668305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization