Provider Demographics
NPI:1275092835
Name:KNIGHTENGALES HOME CARE LLC
Entity Type:Organization
Organization Name:KNIGHTENGALES HOME CARE LLC
Other - Org Name:KNIGHTENGALES HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-620-1106
Mailing Address - Street 1:4990 NEBRASKA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6136
Mailing Address - Country:US
Mailing Address - Phone:937-949-8735
Mailing Address - Fax:937-951-3794
Practice Address - Street 1:4990 NEBRASKA AVE STE 3
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-6136
Practice Address - Country:US
Practice Address - Phone:937-949-8735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0241540Medicaid