Provider Demographics
NPI:1134643471
Name:GAHANNA HOME HEALTHCARE AGENCY, LLC
Entity Type:Organization
Organization Name:GAHANNA HOME HEALTHCARE AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMILA
Authorized Official - Middle Name:A
Authorized Official - Last Name:IDRIS
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:732-877-9776
Mailing Address - Street 1:7451 BUNKER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004
Mailing Address - Country:US
Mailing Address - Phone:732-766-9112
Mailing Address - Fax:
Practice Address - Street 1:7451 BUNKER RIDGE CT
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004
Practice Address - Country:US
Practice Address - Phone:732-766-9112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNA0008184328163WH0200X
347C00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No347C00000XTransportation ServicesPrivate VehicleGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty