Provider Demographics
NPI:1235404666
Name:OHIO HOMECARE PROGRAM
Entity Type:Organization
Organization Name:OHIO HOMECARE PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOME HEALTH AIDE
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MINKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:NA
Authorized Official - Phone:567-225-8629
Mailing Address - Street 1:232 FERRIS AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-1769
Mailing Address - Country:US
Mailing Address - Phone:567-225-8629
Mailing Address - Fax:
Practice Address - Street 1:232 FERRIS AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-1769
Practice Address - Country:US
Practice Address - Phone:567-225-8629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRY914035251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health