Provider Demographics
NPI:1225413107
Name:BABY BOOMERS HOME HEALTH CARE,LLC
Entity Type:Organization
Organization Name:BABY BOOMERS HOME HEALTH CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIRISAK
Authorized Official - Middle Name:AHMED
Authorized Official - Last Name:YUSUF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-888-1100
Mailing Address - Street 1:5200 CLEVELAND AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4756
Mailing Address - Country:US
Mailing Address - Phone:614-888-1100
Mailing Address - Fax:614-888-1101
Practice Address - Street 1:5200 CLEVELAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4756
Practice Address - Country:US
Practice Address - Phone:614-888-1100
Practice Address - Fax:614-888-1101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health