Provider Demographics
NPI:1225465172
Name:MADISON 57 INVESTMENTS LLC
Entity Type:Organization
Organization Name:MADISON 57 INVESTMENTS LLC
Other - Org Name:MADISON HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT ADMINSTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KHEM
Authorized Official - Middle Name:R
Authorized Official - Last Name:DHAMALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-394-9105
Mailing Address - Street 1:6434 E MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-7300
Mailing Address - Country:US
Mailing Address - Phone:614-394-9105
Mailing Address - Fax:
Practice Address - Street 1:6434 E MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-7300
Practice Address - Country:US
Practice Address - Phone:614-394-9105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165026Medicaid